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Utilization of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles After Robotic Radical Prostatectomy and Bilateral Pelvic Lymph Node Dissection. J Endourol 2020; 34:821-827. [DOI: 10.1089/end.2020.0073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kim DK, Parihar JS, Kwon YS, Kim S, Shinder B, Lee N, Farber N, Ahlering T, Skarecky D, Yuh B, Ruel N, Kim WJ, Rha KH, Kim IY. Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study. Asian J Androl 2019; 20:9-14. [PMID: 28440262 PMCID: PMC5753561 DOI: 10.4103/1008-682x.196852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Emerging evidence has suggested that cytoreductive prostatectomy (CRP) allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer (mPCa) has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer (PCa). Urinary incontinence was defined as the use of any pad. CRP had longer operative times (200 min vs 140 min, P < 0.0001) and higher estimated blood loss (250 ml vs 125 ml, P < 0.0001) compared to the control group. However, both overall (8.82% vs 5.85%) and major complication rates (4.41% vs 2.17%) were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group (57.4% vs 90.8%, P < 0.0001). Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model (OR: 1.18; 95% CI: 1.02–1.37; P = 0.025) and surgery type-adjusted model (OR: 1.17; 95% CI: 1.01–1.36; P = 0.034). In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.
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Affiliation(s)
- Dae Keun Kim
- Department of Urology, CHA Seoul Station Medical Center, CHA University, CHA Medical School, Seoul 04637, Korea.,Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul 04763, Korea
| | - Jaspreet Singh Parihar
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
| | - Young Suk Kwon
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA.,Department of Biostatistics, Rutgers School of Public Health, The State University of New Jersey, New Brunswick, NJ Piscataway 08854, USA
| | - Sinae Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA.,Department of Biostatistics, Rutgers School of Public Health, The State University of New Jersey, New Brunswick, NJ Piscataway 08854, USA
| | - Brian Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
| | - Nara Lee
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
| | - Nicholas Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
| | - Thomas Ahlering
- Department of Urology, University of California, Irvine School of Medicine, Orange 92687, USA
| | - Douglas Skarecky
- Department of Urology, University of California, Irvine School of Medicine, Orange 92687, USA
| | - Bertram Yuh
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte 91010, USA
| | - Nora Ruel
- Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte 91010, USA
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju 28644, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, College of Medicine, Yonsei University, Seoul 03722, Korea
| | - Isaac Yi Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick 08901, USA
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Kallappan S, Manickam R, Nachimuthu S, Ganesapandi T. Unusual lymphocele following radical cystectomy with orthotopic neobladder. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2019; 35:168-169. [PMID: 31000926 PMCID: PMC6458803 DOI: 10.4103/iju.iju_284_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 65-year-old male patient, a known case of carcinoma bladder, underwent radical cystectomy with ileal neobladder in 2016. Eleven lymph nodes were identified in the specimen. Histopathology revealed reactive lymphadenitis with sinus histiocytosis. The patient presented with a swelling in the right thigh, associated with dull pain, about 6 months after the procedure. Ultrasound of the right thigh and computed tomography of the region showed an isolated, large, loculated, cystic collection measuring 15 cm × 6 cm with internal septation in the pectineus and adductor longus muscles. Complete aspiration of fluid from the right thigh was done with ultrasound guidance and sent for analysis. The fluid appeared to be lymph, and the lesion turned out to be a lymphocele. There was no recurrence or infection following the aspiration till last follow-up visit. We report this rare lymphocele presentation (in the thigh without any extension from pelvis or groin) after 6 months, following radical cystectomy with neobladder, which was treated by one-time aspiration.
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Affiliation(s)
- Senthil Kallappan
- Department of Urology, Urology Clinic, Gowtham Annexe, Coimbatore, Tamil Nadu, India
| | - Ramalingam Manickam
- Department of Urology, Urology Clinic, Gowtham Annexe, Coimbatore, Tamil Nadu, India
| | | | - Thilak Ganesapandi
- Department of Urology, Urology Clinic, Gowtham Annexe, Coimbatore, Tamil Nadu, India
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Hiester A, Nini A, Niegisch G, Arsov C, Hautzel H, Antke C, Schimmöller L, Albers P, Rabenalt R. Oncological outcome of patients treated with spot-specific salvage lymphnode dissection (sLND) for positron-emission tomography (PET)-positive prostate cancer (PCa) relapse. World J Urol 2019; 37:2081-2090. [DOI: 10.1007/s00345-019-02633-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/07/2019] [Indexed: 11/25/2022] Open
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5
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Post-prostatectomy Lymphocoele Presenting With Renal Failure. Urology 2018; 123:e9-e10. [PMID: 30308260 DOI: 10.1016/j.urology.2018.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/03/2018] [Accepted: 09/24/2018] [Indexed: 11/27/2022]
Abstract
Since its advent in 2001, robotic-assisted laparoscopic prostatectomy has become the gold standard treatment for the management of localized prostate cancer. Pelvic lymphocoele is most commonly found after gynecological or renal transplant surgery or following extensive pelvic lymphadenectomy. Its formation following prostatectomy is not uncommon1 but it seldom causes major complications or morbidity.2 We present a case of a 66-year-old man who presented with left-sided abdominal pain, a palpable infra-umbilical mass, and renal failure. He was initially presumed to have high pressure chronic retention however catheterization did not result in any improvement in his renal function. Further investigations revealed a large lymphocoele causing bilateral ureteric obstruction with resultant hydronephrosis.
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Sathianathen NJ, Risk MC, Konety BR. Lymphadenectomy for Muscle-Invasive Bladder Cancer and Upper Tract Urothelial Cell Carcinoma. Urol Clin North Am 2018; 45:215-228. [PMID: 29650137 DOI: 10.1016/j.ucl.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
There are currently no reported randomized trials that characterize the staging or therapeutic benefit of performing a lymph node dissection in either bladder cancer or upper tract urothelial carcinoma. Several unanswered questions remain in this domain focused on the indications and patient selection for pelvic lymph node dissection, extent of dissection, its impact on outcome, and potential risks. However, the results of observational studies suggest that the burden of metastasis is high in both diseases when muscle invasive and performing a lymphadenectomy can provide prognostic information and yield therapeutic benefit.
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Affiliation(s)
- Niranjan J Sathianathen
- Department of Urology, University of Minnesota, Delaware Street Southeast, Minneapolis, MN 55455, USA
| | - Michael C Risk
- Department of Urology, University of Minnesota, Delaware Street Southeast, Minneapolis, MN 55455, USA
| | - Badrinath R Konety
- Department of Urology, University of Minnesota, Delaware Street Southeast, Minneapolis, MN 55455, USA.
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Schomburg J, Krishna S, Soubra A, Cotter K, Fan Y, Brown G, Konety B. Extended outpatient chemoprophylaxis reduces venous thromboembolism after radical cystectomy. Urol Oncol 2018; 36:77.e9-77.e13. [DOI: 10.1016/j.urolonc.2017.09.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/04/2017] [Accepted: 09/29/2017] [Indexed: 11/30/2022]
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Evaluation of Lymphorrhea and Incidence of Lymphoceles: 4DryField® PH in Radical Retropubic Prostatectomy. Adv Urol 2016; 2016:2367432. [PMID: 27418927 PMCID: PMC4935905 DOI: 10.1155/2016/2367432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/18/2016] [Accepted: 05/15/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To investigate impact of polysaccharide hemostat 4DryField PH (4DF) applied on lymph node dissection area after radical retropubic prostatectomy (RRP) on lymphorrhea and lymphocele (LC) formation. Methods. 104 consecutive patients underwent RRP, 51 without 4DF treatment (CT-group) and 53 with 4DF treatment (4DF-group). Groups were comparable (age, risk profile, and lymph node numbers). Postoperative drain loss (PDL) and development of early and late LC were analyzed (mean follow-up at 7 months: 100%). Results. PDL was 452.5 ± 634.2 mL without and 308.5 ± 214 mL with 4DF treatment. PDL > 1000 mL only occurred in CT-group (5/51). Overall, 45 LC (26 in CT- versus 19 in the 4DF-group) were diagnosed. At day 8, LC were equally distributed between groups. Incidence of late LC, however, was twice in controls (16/51) versus 4DF-patients (8/53). Symptomatic LC (4 in untreated patients, 2 in 4DF-patients) were treated with percutaneous drainage (duration: 45 days in untreated patients versus 12 days in 4DF-patients). Conclusion. Application of 4DF on lymph node dissection areas lessened total drain loss and significantly lowered high volume drain loss. Furthermore, 4DF reduced frequency of late lymphoceles and lymphoceles requiring treatment by half, as well as duration of percutaneous drainage by more than two-thirds.
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Sahbaz A, Gungorduk K, Gulseren V, Ozdemir IA, Harma M, Harma M, Sancı M. What Are the Risk Factors for Lymphocyst Formation Apart From Lymphnode Dissection and Lymphnode Count in Gynecologic Malignancy? Geburtshilfe Frauenheilkd 2016; 76:403-407. [PMID: 27134296 DOI: 10.1055/s-0041-110804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Aim: Lymphocyst is one of the most common complications of lymphadenectomy and generally encountered during uro-gynecological oncology surgeries. We aimed to define the risk factors for formation of a lymphocyst in patients with various gynecological cancer types in whom a lymphadenectomy was performed. Methods: This retrospective study was performed on 206 patients. Of the 206 patients, 100 were diagnosed with a lymphocyst, and 106 were assigned to a control group. Laboratory findings and surgical characteristics of the patients were compared. Results: No differences were observed in age, pre-operative hemoglobin; platelet, white blood cell, and lymphocyte counts; or pre-operative albumin level (p = 0.315, 0.500, 0.525, 0.683, 0.740, and 0.97, respectively). A significant effect of the heparin dose × heparin days interaction and lymphocyst formation was observed (p = 0.002). Lymphocysts were most frequently detected in the ovarian cancer subgroup (49 %). Significant differences were detected between the groups in the percentages of patients who underwent CT only and RT only treatments (p = 0.001 and 0.002, respectively). The logistic regression analysis revealed a relationship between the LMWH dose × days interaction and formation of a lymphocyst (OR, 1.10; 95 % CI, 1.0-1.13; p = 0.01). Conclusion: The association between total LMWH dose administered and the formation of lymphocysts in patients with gynecological pelvic cancer was investigated for the first time. Significant relationship between heparin dose × days and lymphocyst formation was found. Although anticoagulation with LMWH is essential for preventing thromboembolism, it should be used appropriately to prevent other complications, such as bleeding and lymphocysts.
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Affiliation(s)
- A Sahbaz
- Zonguldak Bulent Ecevit University School of Medicine, Department of Obstetrics and Gynecology, Zonguldak, Turkey
| | - K Gungorduk
- Izmir Tepecik Research and Training Hospital, Department of Gynecology and Oncology, Izmir, Turkey
| | - V Gulseren
- Izmir Tepecik Research and Training Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - I A Ozdemir
- Bakirkoy Sadi Konuk Research and Training Hospital, Department of Gynecology and Oncology, Istanbul, Turkey
| | - M Harma
- Zonguldak Bulent Ecevit University School of Medicine, Department of Obstetrics and Gynecology & Obstetrics and Gynecology, Zonguldak, Turkey
| | - M Harma
- Zonguldak Bulent Ecevit University School of Medicine, Department of Obstetrics and Gynecology & Obstetrics and Gynecology, Zonguldak, Turkey
| | - M Sancı
- Izmir Tepecik Research and Training Hospital, Department of Gynecology and Oncology, Izmir, Turkey
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Schmitges J, Trinh QD, Jonas L, Budäus L, Larbig R, Schlomm T, Karakiewicz P, Heinzer H, Huland H, Graefen M, Steuber T. Influence of low-molecular-weight heparin dosage on red blood cell transfusion, lymphocele rate and drainage duration after open radical prostatectomy. Eur J Surg Oncol 2012; 38:1082-8. [DOI: 10.1016/j.ejso.2012.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 07/08/2012] [Accepted: 08/02/2012] [Indexed: 11/28/2022] Open
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Efficacy of Octreotide for Management of Lymphorrhea After Pelvic Lymph Node Dissection in Radical Prostatectomy. Urology 2010; 76:398-401. [DOI: 10.1016/j.urology.2009.04.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 04/22/2009] [Accepted: 04/29/2009] [Indexed: 11/17/2022]
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12
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Tomic R, Granfors T, Sjödin JG, Öhberg L. Lymph Leakage After Staging Pelvic Lymphadenectomy for Prostatic Carcinoma with and Without Heparin Prophylaxis. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/00365599409181277] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R. Tomic
- Departments of Urology and Andrology, University of Umeå, Sweden
| | - T. Granfors
- Departments of Urology and Andrology, University of Umeå, Sweden
| | - J.-G Sjödin
- Departments of Urology and Andrology, University of Umeå, Sweden
| | - L. Öhberg
- Department of Radiology, University of Umeå, Sweden
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Sun GH, Fu YT, Wu CJ, Chang SY. POVIDONE-IODINE INSTILLATION FOR MANAGEMENT OF PELVIC LYMPHOCELE AFTER PELVIC LYMPHADENECTOMY FOR STAGING PROSTATE CANCER. ACTA ACUST UNITED AC 2009; 49:463-6. [PMID: 14555330 DOI: 10.1080/01485010390219935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The development of postoperative lymphoceles following pelvic lymph node dissection is a rare complication. It is a well-described complication of kidney transplantation. A patient who developed a symptomatic pelvic lymphocele after pelvic lymph node dissection for staging prostatic cancer was treated with percutaneous tube drainage, but the treatment was in vain. Successful treatment was accomplished with povidone-iodine instillation into the lymphocele. This simple, safe, and painless method for lymphocele treatment is recommended.
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Affiliation(s)
- G-H Sun
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, National Defense University, No. 325, Section 2 Cheng-Gung Road, Neihu 114, Taipei, Taiwan, ROC.
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Atmaca AF. Re: Complications of pelvic lymphadenectomy in 1,380 patients undergoing radical retropubic prostatectomy between 1993 and 2006: M. Musch, V. Klevecka, U. Roggenbuck and D. Kroepfl J Urol 2008; 179: 923-929. J Urol 2008; 180:2715; author reply 2715-6. [PMID: 18951577 DOI: 10.1016/j.juro.2008.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Indexed: 11/28/2022]
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Jessie BC, Marshall FF. Pharmacological prophylaxis of venous thromboembolism in contemporary radical retropubic prostatectomy: Does concomitant pelvic lymphadenectomy matter? Int J Urol 2008; 15:951-6. [DOI: 10.1111/j.1442-2042.2008.02155.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kawakami J, Meng MV, Sadetsky N, Latini DM, Duchane J, Carroll PR. Changing Patterns of Pelvic Lymphadenectomy for Prostate Cancer: Results From CaPSURE™. J Urol 2006; 176:1382-6. [PMID: 16952638 DOI: 10.1016/j.juro.2006.06.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE Widespread screening for prostate cancer in the United States has resulted in earlier tumor identification at lower stages. The fewer number of men with lymph node metastases at initial presentation has altered patterns of pelvic lymphadenectomy before definitive treatment. We characterized patterns of pelvic lymphadenectomy in conjunction with radical prostatectomy in a community based cohort. MATERIALS AND METHODS In the CaPSURE database we identified men undergoing radical prostatectomy. Patients were stratified into 3 clinical risk groups based on serum prostate specific antigen, T stage and pathological grade. We examined temporal trends of pelvic lymphadenectomy and predictors of pelvic lymphadenectomy. RESULTS From 1992 to 2004 the proportion of men undergoing pelvic lymphadenectomy in conjunction with radical prostatectomy decreased from 94% to 80%. Overall positive lymph nodes were identified in 0.87%, 2.0% and 7.1% of men in the low, intermediate and high risk groups, respectively. While men with high risk disease continued to undergo pelvic lymphadenectomy at a high rate (greater than 90%), the fraction of men at low and intermediate risk undergoing pelvic lymphadenectomy steadily decreased. Prostate specific antigen, Gleason sum, clinical stage and income were factors associated with pelvic lymphadenectomy. A mean of 5.7 lymph nodes (median 5.0) were removed. CONCLUSIONS The performance of pelvic lymphadenectomy has decreased in patients at low and intermediate risk, and remained stable in patients at high risk. Further investigation of the role of extended pelvic lymphadenectomy and the potential therapeutic benefits of pelvic lymphadenectomy would better define the contemporary role of pelvic lymphadenectomy and identify appropriate candidates.
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Affiliation(s)
- Jun Kawakami
- Urologic Outcomes Research Group, Program in Urologic Oncology, Department of Urology, University of California-San Francisco Comprehensive Cancer Center, University of California-San Francisco, California 94115-1711, USA
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Pepper RJ, Pati J, Kaisary AV. The incidence and treatment of lymphoceles after radical retropubic prostatectomy. BJU Int 2005; 95:772-5. [PMID: 15794780 DOI: 10.1111/j.1464-410x.2005.05398.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the incidence and treatment of lymphoceles after retropubic radical prostatectomy (RP). PATIENTS AND METHODS Up to January 2004, 260 patients who had a retropubic RP in one institution by one surgeon were assessed retrospectively, using the patients' notes or the computerized results system to determine whether a lymphocele was suspected and then confirmed by imaging studies (computed tomography or ultrasonography). RESULTS Nine patients developed symptomatic lymphoceles; eight of these were detected by imaging. Four lymphoceles required intervention while the remainder regressed spontaneously. No complications were reported in the group that was treated. CONCLUSION The rate of symptomatic lymphocele formation was low after RP, with an overall incidence of 3.5%. Ultrasonography was effective in detecting lymphoceles and ultrasonographically guided percutaneous drainage an effective treatment.
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Affiliation(s)
- Ruth J Pepper
- Department of Urology, Royal Free Hospital, London, UK
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Bassi PF, DE Marco V, Tavolini IM, Dal Moro F, Battaglia D, Aragona M, Longo F. Nodal Involvement in Bladder Cancer. Urologia 2004. [DOI: 10.1177/039156030407100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are many controversies about the actual meaning of nodal involvement in bladder cancer and, subsequently, about the real benefit of pelvic lymph node dissection (PLND) in patients with positive nodes at the time of cystectomy. In this article we reviewed the literature about the role of nodal involvement and the impact of positive nodes on the prognosis. The finding of positive nodes after radical cystectomy and PLND makes generally consider bladder cancer as a systemic disease and it is associated with poor prognosis. Therefore many urologists don't perform radical surgery in patients with positive nodes at time of cystectomy. P category, N category, and distant metastases are the most important factors in determining the outcome of patients with bladder cancer with nodal involvment. PLND is necessary for accurate staging in bladder cancer and appears to benefit patients with limited nodal involvement. PLND should be considered as a standard procedure that should be performed in every patient with indication of surgical treatment for TCC of the bladder.
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Affiliation(s)
- PF. Bassi
- Clinica Urologica, Università degli Studi di Padova, Padova
| | - V. DE Marco
- Clinica Urologica, Università degli Studi di Padova, Padova
| | - IM. Tavolini
- Clinica Urologica, Università degli Studi di Padova, Padova
| | - F. Dal Moro
- Clinica Urologica, Università degli Studi di Padova, Padova
| | - D. Battaglia
- Clinica Urologica, Università degli Studi di Padova, Padova
| | - M. Aragona
- Clinica Urologica, Università degli Studi di Padova, Padova
| | - F. Longo
- Clinica Urologica, Università degli Studi di Padova, Padova
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Solberg A, Angelsen A, Bergan U, Haugen OA, Viset T, Klepp O. Frequency of lymphoceles after open and laparoscopic pelvic lymph node dissection in patients with prostate cancer. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2003; 37:218-21. [PMID: 12775280 DOI: 10.1080/00365590310008082] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare the frequencies of pelvic lymphocele formation after laparoscopic and open pelvic lymph node dissection in patients with prostate cancer. MATERIAL AND METHODS A total of 132 patients operated on with pelvic lymph node dissection (PLND) underwent CT scanning of the abdomen and pelvis at a median of 29 days postoperatively. Open pelvic lymph node dissection (OPLND) was performed in 94 patients (71%) and 38 patients (29%) were operated on using a laparoscopic technique (LPLND). The frequency and size of pelvic lymphoceles were registered. Lymphoceles with a horizontal diameter of </=4.9 cm were classified as small and those with a horizontal diameter of >/=5.0 cm were classified as large. RESULTS The overall frequency of lymphoceles was 54%. The frequencies in the OPLND and LPLND groups were 61% and 37%, respectively. A total of 27% of the OPLND patients had large lymphoceles, compared to 8% of the LPLND patients. Three patients (2.3%), all in the OPLND group, had clinically significant lymphoceles. CONCLUSIONS Although the overall frequency of lymphocele formation was high, clinically significant lymphoceles were scarce. LPLND was associated with a statistically significant lower frequency of lymphocele formation compared to OPLND.
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Affiliation(s)
- Arne Solberg
- Department of Oncology, University Hospital Trondheim, Norway
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Indications for Pelvic Lymphadenectomy. Prostate Cancer 2003. [DOI: 10.1016/b978-012286981-5/50029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Clearly, pelvic lymphadenectomy can provide important staging information in the management of prostate cancer, but this benefit is counterbalanced by a modest increase in morbidity and the significant cost of the procedure. It is difficult to provide universal recommendations concerning the indications for pelvic lymphadenectomy. Part of the problem lies in the fact that urologists perform pelvic lymphadenectomy for several different reasons. Some surgeons perform pelvic lymphadenectomy to better counsel patients after radical prostatectomy about their risk for disease progression and for planning adjuvant radiotherapy or hormonal therapy. For these surgeons, preoperative clinical staging parameters do not exclude patients from pelvic lymphadenectomy, and frozen section analysis intraoperatively provides no useful information. Alternatively, the staging information from pelvic lymphadenectomy can be used to justify cancellation of the subsequent prostatectomy should regional spread of prostate cancer be identified, sparing the patient the morbidity of an unnecessary radical prostatectomy. With this approach, despite the false-negative rate of up to 30%, the expense of frozen section analysis seems justified. For this second group of surgeons, the problem becomes balancing the modest morbidity and cost of pelvic lymphadenectomy against the probability that nodal spread of prostate cancer will be missed if the procedure is omitted. The authors consider a greater than 4% risk for missing regional disease to be unacceptable in this setting. Following this assumption, Table 3 outlines parameters for clinical stage, Gleason score, and preoperative PSA within which pelvic lymphadenectomy is indicated. These recommendations are based on [table: see text] predictions from the Partin nomogram, which has been validated using a series of over 4000 patients. For the large number of patients with clinical T1c disease and a preoperative PSA less than 10 ng/mL, bilateral pelvic lymphadenectomy is indicated only if prostate biopsy identifies tumor of Gleason grade 4 or higher. For lower-grade tumors in this patient population, the risk for nodal metastasis was less than 5% in the Johns Hopkins and Mayo Clinic series of over 5800 patients with prostate cancer. For a large pool of patients, the several thousand dollar cost of pelvic lymphadenectomy and the risk for injury to the obturator nerves and vessels, the formation of lymphoceles, and chronic genital edema can be eliminated with low risk. A nomogram-based approach provides only a starting point for a decision analysis framework to determine whether the surgeon should perform lymphadenectomy at the time of radical prostatectomy because current nomograms predict only lymph node positivity. In a decision analysis framework, some patient and physician value is derived from a negative lymphadenectomy. Moreover, the morbidity associated with pelvic lymphadenectomy and the potential inconvenience associated with treating such morbidity also would be factored into the decision. Consequently, a decision analysis framework that takes into account prognostic value, costs, morbidity, and health state uses ultimately will provide the most informative method for determining when pelvic lymphadenectomy is indicated in patients with prostate cancer.
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Affiliation(s)
- R E Link
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA
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22
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Affiliation(s)
- L L Glass
- Department of Urology, University of Rochester School of Medicine, New York 14642, USA
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23
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Abstract
OBJECTIVE Lymphocele formation has been infrequently reported as a complication of laparoscopic pelvic lymph node dissection (LPLND). We determined the incidence of clinical and subclinical lymphocele formation in patients undergoing transperitoneal LPLND. METHODS Charts and radiological records of 111 patients undergoing transperitoneal LPLND at this institution between January 1991 and December 1995 were reviewed to determine the incidence of lymphocele formation. RESULTS Of 111 patients undergoing LPLND, 12.6% had positive lymph nodes and received hormonal therapy. Radical retropubic (12) or perineal (28) prostatectomy was performed either simultaneously or within 2 weeks in 41% of the node-negative patients. Radiation therapy was the treatment modality in the remaining node negative patients (N = 57). Twenty-three patients undergoing radiation therapy had preplanning pelvic computed tomography (CT) scans 2 to 16 weeks (mean 8.2 weeks) after LPLND. These were reviewed by a single radiologist to determine the presence of subclinical lymphoceles. Seven patients (30.4%) had lymphoceles of varying sizes (3 large and 4 small). Although most were identified on CT scans 4 weeks after the procedure, two were identified on scans 12 and 16 weeks after the procedure (mean 6.5 weeks). None of these patients developed symptoms referable to or had treatment for the lymphocele during a 2 to 37 month follow-up (mean 20 months). Only two patients (3.5%) undergoing LPLND as an isolated procedure had clinical evidence of lymphocele formation, both of which were subsequently confirmed with CT scans (1 large, 1 small). One was treated with CT-guided drainage and sclerosis and the other resolved spontaneously. CONCLUSION The clinical incidence of lymphocele formation following LPLND remains relatively low. Only a portion of these patients requires intervention. Subclinical lymphoceles, as detected on follow-up CT scans, occur with a much greater frequency. These seldom become symptomatic requiring treatment. Rather, they appear to resolve spontaneously. Nevertheless, clinical suspicion should remain high in order to detect and properly treat symptomatic lymphoceles when they occur.
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Affiliation(s)
- R M Freid
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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24
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25
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Abstract
Comparative studies have proven the feasibility as well as reduced morbidity of endoscopic pelvic lymph node dissection when compared to open pelvic lymphadenectomy. Transperitoneal laparoscopic pelvic lymphadenectomy, however, has been associated with complications related to transperitoneal access and intraperitoneal dissection. We, therefore, developed the extraperitoneal laparoscopic staging pelvis lymph node dissection which combines the anatomic principles of open pelvic lymphadenectomy with the minimally invasive endoscopic technique. Exploration of the area of our endoscopic lymphadenectomy during radical retropubic prostatectomy proved the feasibility of our dissection. In patients selected for laparoscopic lymphadenectomy, we now prefer the extraperitoneal approach.
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Affiliation(s)
- S Das
- Department of Urology, Kaiser Permanente Medical Center, Walnut Creek, California, USA
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26
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Carbone JM, Nadler RB, Bullock AD, Basler JW. Delayed infection of a pelvic lymphocele following pelvic lymphadenectomy. Urology 1996; 47:140-2. [PMID: 8560652 DOI: 10.1016/s0090-4295(99)80402-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pelvic lymphocele is an infrequent complication of pelvic surgery, usually presenting shortly after surgery. We report a case of an infected pelvic lymphocele presenting more than 1 year after a staging pelvic lymphadenectomy for adenocarcinoma of the prostate. This case illustrates that late infection of pelvic lymphoceles can occur following a pelvic lymphadenectomy and radical prostatectomy.
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Affiliation(s)
- J M Carbone
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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27
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Goh M, Kantoff P, Kavoussi LR. Retroperitoneal lymphocele formation after selective laparoscopic retroperitoneal lymph node sampling. J Urol 1994; 151:1626-8. [PMID: 8189580 DOI: 10.1016/s0022-5347(17)35321-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Laparoscopic retroperitoneal lymph node sampling is being evaluated at several institutions as a minimally invasive alternative to evaluate pathologically retroperitoneal lymph nodes in cases of clinical stage A testis tumor. We report on the development of a symptomatic lymphocele after selective laparoscopic retroperitoneal lymph node sampling.
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Affiliation(s)
- M Goh
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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28
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Abstract
As laparoscopic techniques develop, endoscopic lymph node dissection is becoming preferred as the minimally invasive technique for lymph node staging of pelvic malignancies. We developed an extraperitoneal laparoscopic approach to staging pelvic lymphadenectomy, and describe our technique, results and experience in our initial 9 patients.
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Affiliation(s)
- S Das
- Department of Urology, Kaiser Permanente Medical Center, Walnut Creek, California 94596-5300
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29
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Etwaru D, Raboy A, Ferzli G, Albert P. Extraperitoneal endoscopic gasless pelvic lymph node dissection. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1994; 4:113-6. [PMID: 8043918 DOI: 10.1089/lps.1994.4.113] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The insufflated extraperitoneal approach to endoscopic pelvic lymph node dissection has been described as an alternative method of staging carcinoma of the prostate. There are several potential pitfalls in performing this approach, including the use of endoscopic instrumentation, trocars, insufflation equipment, and general anesthesia. In order to overcome potential problems associated with this surgical approach, a totally gasless extraperitoneal approach has been developed. This technique uses standard surgical instruments, does not use carbon dioxide to maintain the operative space, and uses general anesthesia. This procedure is more cost effective, since it uses no special instrumentation except the laprolift and laprofan to maintain the extraperitoneal cavity during lymph node dissection.
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Affiliation(s)
- D Etwaru
- Department of Urology and Laparoendoscopic Surgery, Staten Island University Hospital-A Division of SUNY Health Science Center at Brooklyn, New York
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30
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McDougall EM, Clayman RV. Endoscopic management of persistent lymphocele following laparoscopic pelvic lymphadenectomy. Urology 1994; 43:404-7. [PMID: 8135000 DOI: 10.1016/0090-4295(94)90091-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To report an alternative form of management of a persistent lymphocele that was unresponsive to percutaneous drainage and ethanol sclerotherapy. METHODS Herein is described the technique of dilating the previously established percutaneous drainage tract to facilitate insertion of a flexible ureteroscope. Through this instrument electrosurgical fulguration of the lymphocele cavity was performed. RESULTS The patient had complete resolution of the lymphocele cavity on computed tomography (CT) scan and remains asymptomatic at six months of follow-up. CONCLUSIONS Flexible ureteroscopic access and fulguration of a lymphocele proved to be a safe and effective method of obliterating the lymphocele cavity.
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Affiliation(s)
- E M McDougall
- Department of Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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31
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Albala DM, Kevwitch MK, Waters WB. Treatment of persistent lymphatic drainage after laparoscopic pelvic lymph node dissection and radical retropubic prostatectomy. J Endourol 1993; 7:337-40. [PMID: 8252030 DOI: 10.1089/end.1993.7.337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A patient with a lymphocele after laparoscopic pelvic lymphadenectomy and radical retropubic prostatectomy was treated successfully with a single instillation of diatrizoate meglumine through a Jackson-Pratt drain. The authors review the origin of lymphoceles and various methods for treating them.
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Affiliation(s)
- D M Albala
- Department of Urology, Loyola University Medical Center, Maywood, IL
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32
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Carrington BM, Johnson RJ. Atypical pelvic lymphocele: sonographic appearance. JOURNAL OF CLINICAL ULTRASOUND : JCU 1993; 21:119-123. [PMID: 8381131 DOI: 10.1002/jcu.1870210208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- B M Carrington
- Department of Diagnostic Radiology, Christie Hospital and Holt Radium Institute, Manchester, United Kingdom
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33
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Bigg SW, Catalona WJ. Prophylactic mini-dose heparin in patients undergoing radical retropubic prostatectomy. A prospective trial. Urology 1992; 39:309-13. [PMID: 1557840 DOI: 10.1016/0090-4295(92)90203-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We initiated a prospective, partially randomized trial of the effects of perioperative prophylactic mini-dose heparin on the incidence of clinically evident pulmonary emboli, intraoperative blood loss, blood transfusions, duration of postoperative pelvic drainage, and lymphocele formation in 68 consecutive patients undergoing radical retropubic prostatectomy. We treated 32 patients with mini-dose heparin and 36 without it. We detected pulmonary emboli in 4 (11%) patients not treated with mini-dose heparin and in none treated with heparin (p = 0.052). Anesthesiologists estimated a mean intraoperative blood loss of 2,152 cc in the heparinized patients compared with 1,886 cc in controls (p = 0.2). At a time when our policy was to replace all blood loss, we transfused a mean of 3.9 units to heparinized patients and 3.2 units to controls (p = 0.1). Persistent lymphatic drainage requiring more than six days of closed suction drainage occurred in 12 of 32 (38%) heparinized patients as compared with 4 of 36 (11%) controls (p = 0.01). We discontinued the study after 68 patients because of the morbidity associated with mini-dose heparin. Because of the associated morbidity we do not recommend the routine use of mini-dose heparin in patients undergoing radical prostatectomy.
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Affiliation(s)
- S W Bigg
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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34
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Ferzli G, Trapasso J, Raboy A, Albert P. Extraperitoneal endoscopic pelvic lymph node dissection. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1992; 2:39-44. [PMID: 1533548 DOI: 10.1089/lps.1992.2.39] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Laparoscopic pelvic lymphadenectomy has been found to be efficacious in the staging of genitourinary cancers. Technological advances in endoscopic instrumentation have allowed an extraperitoneal approach to be performed. Presented are two patients who underwent an extraperitoneal endoscopic lymph node dissection as a staging procedure for prostatic carcinoma. Technical aspects of the procedure and advantages relative to the laparoscopic intraperitoneal approach are discussed.
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Affiliation(s)
- G Ferzli
- Department of EndoLaparoscopic Surgery and Urology, Staten Island University Hospital, NY
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35
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McDowell GC, Babaian RJ, Johnson DE. Management of symptomatic lymphocele via percutaneous drainage and sclerotherapy with tetracycline. Urology 1991; 37:237-9. [PMID: 1825736 DOI: 10.1016/0090-4295(91)80292-f] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lymph collections following pelvic surgery are usually asymptomatic, but may occasionally produce symptoms requiring invasive therapy. We have successfully obliterated a large lymphocele by employing percutaneous drainage and instilling tetracycline.
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Affiliation(s)
- G C McDowell
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston
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36
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Affiliation(s)
- R F Gittes
- Scripps Clinic and Research Foundation, La Jolla, CA 92037
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37
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Abstract
A case report of a pelvic lymphocele developing after lymphadenectomy for staging of prostatic carcinoma is described. This collection was successfully managed by percutaneous catheter drainage. The incidence, pathophysiology, clinical symptomatology, differential diagnosis, and treatment options of pelvic lymphocele are reviewed. We believe that percutaneous catheter drainage is currently the optimal treatment modality.
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Affiliation(s)
- J H Heyman
- Department of Urology, Beth Israel Medical Center, New York, New York
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38
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Ojeda L, Sharifi R, Lee M, Mouli K, Guinan P. Lymphocele formation after extraperitoneal pelvic lymphadenectomy: possible predisposing factors. J Urol 1986; 136:616-8. [PMID: 3735537 DOI: 10.1016/s0022-5347(17)44994-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A retrospective review of 61 patients undergoing pelvic lymphadenectomy was performed to assess possible predisposing factors for lymphocele development. The procedure was done to facilitate staging of prostatic carcinoma in all of the patients. The complication occurred in 9 patients (14.8 per cent). Analysis revealed a statistically significantly higher incidence of lymphoceles in patients without drainage (p less than 0.05) and in patients whose lymph nodes had no metastatic disease (p less than 0.025). Furthermore, 9 patients (without drainage and with nodes that were free of tumor but who received mini-dose heparin therapy) as a subgroup had the highest incidence of lymphocele formation. Although these individual factors have been attributed to this complication after lymphadenectomy they may act synergistically.
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39
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Choo YC, Wong LC, Wong KP, Ma HK. The management of intractable lymphocyst following radical hysterectomy. Gynecol Oncol 1986; 24:309-16. [PMID: 3721302 DOI: 10.1016/0090-8258(86)90307-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Six cases of intractable lymphocyst occurred in a series of 108 patients undergoing radical hysterectomy, an incidence rate of 5.6%. The complexities of pelvic lymphocyst are illustrated by their unusual presentation and problems in their management. Large lymphocysts should initially be treated by percutaneous catheter drainage before resorting to peritoneal marsupialization.
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40
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Abstract
A patient is presented in whom a lymphocele developed after a retroperitoneal lymph node dissection for Stage II embryonal carcinoma of the testicle. The benign nature of this lymphocele has been confirmed not only by the diagnostic procedures outlined, but by its stability over a 42-month follow-up period with no further antitumor therapy. We conclude from reviewing the literature that while aggressive measures are necessary to confirm the diagnosis of a lymphocele, its management should be expectant. If significant obstruction of neighboring structures occurs, an attempt at percutaneous drainage (and possibly sclerosis) seems appropriate despite potential risks of interventional treatment such as hemorrhage and introduction of infection. Open procedures for marsupialization and drainage should be reserved for cases in which more conservative measures fail.
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41
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Meazza A, Prestini G, Zeoli M. Le Complicanze Precoci Della Cistectomia Radicale per Carcinoma Vescicale. Urologia 1984. [DOI: 10.1177/039156038405100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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42
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Ali Khan S, Hu KN. Internal drainage of lymphocele by a pedicled omental flap. Int Urol Nephrol 1983; 15:333-8. [PMID: 6662653 DOI: 10.1007/bf02082553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
An unusual case of huge pelvic and retroperitoneal lymphocele following bilateral pelvic lymphadenectomy is presented. The lymphocele was successfully managed by the procedure of internal drainage with pedicled omental flap.
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