Clinical Significance of Postoperative Lymphoceles Following Pelvic Lymph Node Dissection in Prostate Cancer Disease

Background and Aims: Pelvic lymph node dissection (pLND) in patients undergoing radical retropubicprostatectomy (rRPE) is often associated with postoperative lymphocele formation. This can lead to consecutivecomplications such as abscesses and thrombosis. The aim of this study was to evaluate the possible risk ofcomplications due to the lymph node dissection and to identify risk factors being associated with symptomaticlymphoceles.Methods: Between 02/2002 and 12/2003 all 504 patients who underwent pLND and rRPE were investigated onthe 7th postoperative day by pelvic and lower abdominal ultrasound. Volumes of lymphoceles were determined.Complications related to pLND were described and evaluated statistically to explore the role of possible riskfactors.Results: 66 patients (13%) (mean age 63, range 48-75 years) developed a lymphocele. There was nostatistically relevant association between size of lymphoceles and age of patients, pre-surgical PSA, T-stage,prostate volume and the number of lymph nodes being removed, the body mass index and duration of surgicalprocedures. The size of lymphoceles was in 47% of patients 50 ml, in 15.2 % between 50-100 ml, in 25.8%between 100 and 200 ml and in 12.1% of patients 200ml. The mean volume of the lymphoceles was 111.6 ml(Median 80 ml). 13 patients developed complications such as thrombosis and abscesses. The mean volume oflymphoceles being clinically symptomatic was 227±125ml and in asymptomatic patients it was 87±65 ml. Thisdifference was statistically significant (p 0.001).Conclusions: Because of simple feasibility, universal availability as well as low costs, a pelvic ultrasoundshould be performed in the clinical setting after removal of all drains. Asymptomatic lymphoceles with a volumeless than 100 ml do not need any particular close follow-up. Facing larger lymphoceles invasive means shouldbe planned rather early to avoid complications.