Presented by: eric qualkenbush MD
Mayo Clinic Florida

Introduction

Extended pelvic lymphadenectomy during robotic prostatectomy carries the risk of lymphocele formation, which can cause complications such as infection, deep vein thrombosis, and pain. Peritoneal window is an easy, single step technique performed during lymph node dissection. Therefore, the objective of this study was to evaluate whether the peritoneal window technique would be associated with reduced incidence of symptomatic lymphocele formation after extended pelvic lymphadenectomy.

Materials

Patients who underwent a robotic prostatectomy with extended pelvic lymph node dissection by a single surgeon from 2018 to 2022 were identified. The exposure of interest was peritoneal window technique. The peritoneal window was created by excising the portion of peritoneum overlying the pelvic lymph nodes and iliac vessels at the time of lymphadenectomy. The surgeon documented peritoneal window technique in the operative note when performed. The primary outcome was symptomatic lymphocele. Statistical analysis was performed using Kruskal-Wallis test for continuous variables and chi squared test for categorical variables with p <0.05 considered significant.

Results

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Between 2018 and 2022, we identified 147 patients who underwent robotic assisted radical prostatectomy with extended pelvic lymph node dissection. Of whom, 101 (69%) received the peritoneal window technique, while 46 (31%) did not. Clinicopathologic variables are summarized in table 1. Five patients developed symptomatic lymphocele at a median of 23 days postoperatively (IQR 12-46 days). No patients with a peritoneal window developed a symptomatic lymphocele (P= <0.001). 

Conclusion

The creation of a peritoneal window during an extended pelvic lymphadenectomy for prostate cancer was associated with a significant reduction in symptomatic lymphoceles. The peritoneal window is an easy, one-step technique that potentially prevent lymphoceles and warrants further study.

Funding

none

Lead Authors

Amanda Myers, MD
Mayo Clinic Florida

Yeonsoo Lee, BS
Mayo Clinic Florida

Sarah Hapton, MD
Mayo Clinic Florida

Jared Schommer, MD, PHD
Mayo Clinic Florida

Raymond Pak, MD, MBA
Mayo Clinic Florida