Surgical Strategies for Lymphocele Prevention in Minimally Invasive Radical Prostatectomy and Lymph Node Dissection: A Systematic Review

Giovanni Motterle, Alessandro Morlacco, Nicola Zanovello, Mohamed E. Ahmed, Filiberto Zattoni, Robert Jeffrey Karnes, Fabrizio Dal Moro

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Purpose: Pelvic lymph node dissection is an important step during robotic radical prostatectomy. The collection of lymphatic fluid (lymphocele) is the most common complication with potentially severe impact; therefore, different strategies have been proposed to reduce its incidence. Materials and Methods: In this systematic review, EMBASE, MEDLINE, Cochrane Library, and NIH Registry of Clinical Trials were searched for articles including the following interventions: transperitoneal vs extraperitoneal approach, any reconfiguration of the peritoneum, the use of pelvic drains, and the use of different sealing techniques and sealing agents. The outcome evaluated was the incidence of symptomatic lymphocele. Randomized, nonrandomized, and/or retrospective studies were included. Results: Twelve studies were included (including one ongoing randomized clinical trial). Because of heterogeneity of included studies, no meta-analysis was performed. No significant impact was reported by different sealing techniques and agents or by surgical approach. Three retrospective, nonrandomized studies showed a potential benefit of peritoneal reconfiguration to maximize the peritoneal surface of reabsorption. Conclusion: Lymphocele formation is a multistep and multifactorial event; high-quality literature analyzing risk factors and preventive measures is rather scarce. Peritoneal reconfiguration could represent a reasonable option that deserves further evaluation; no other preventive measure is supported by current evidence.

Original languageEnglish (US)
Pages (from-to)113-120
Number of pages8
JournalJournal of endourology
Volume34
Issue number2
DOIs
StatePublished - Feb 2020

Keywords

  • lymph node dissection
  • lymphocele
  • prostate cancer
  • prostatectomy

ASJC Scopus subject areas

  • Urology

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