Presented by: Konstantin Skrupskiy MD
Moscow State Medical and Dental University named after A.I. Evdokimova of the Ministry of Health of the Russian Federation

Introduction

Pelvic lymphadenectomy is a therapeutic and diagnostic manipulation that allows to evaluate lymph nodes metastasis, but also to provide the most accurate staging after radical prostatectomy. Lymphocele is the most common complication after pelvic lymphadenectomy robot-assisted radical prostatectomy.

Materials

Objective: To develop prophylaxis lymphogenic complications after robot-assisted pelvic lymphadenectomy.

Design, setting, and participants: prospective randomized single-center study including patients with prostate cancer (cT1-3N0M0) who underwent robot-assisted radical prostatectomy with pelvic lymphadenectomy between September 2022 and December 2022. Patients were randomized into 3 groups:

1. A group of patients with fixation of a free peritoneal flap to the pubic bone;

2. A group of patients use of the lymphostatic drug «Lymphoblock»;

3. Control group.

Measurements: The main objective of the study was to assess the frequency lymphocele during follow-up period.

Results

,

79 patients included in the study. The median follow-up was 90 d. There were no differences between the groups regarding clinical and pathological variables. The patients were divided into 3 groups: group 1 - fixation group (n-26), group 2 - «Lymphoblock» (n-26); group 3 – control group (n - 27). After surgery, lymphocele was diagnosed in 8 (10.1%) patients: group 1 - 2 (2.5%) patients, group 2 - 1 (1.3%), group 3 - 5 (6.3%). Lymphocele in the fixation groups and use of the lymphostatic drug «Limfobok» was asymptomatic and had absolutely no clinical symptoms.  Symptomatic lymphocele was diagnosed in 2 (2.5%) patients of the comparison group.

Conclusion

The surgical method of a free peritoneal flap fixation to the pubic bone during robot-assisted radical prostatectomy and pelvic lymphadenectomy and the use of the lymphostatic drug Lymphoblock can reduce the incidence of lymphocele formation compared to the standard technique. The use of preventive measures complex can be recommended for routine use in patients who underwent robot-assisted radical prostatectomy and pelvic lymphadenectomy.

Funding

Not fundidng

Lead Authors

Konstantin Kolontarev, PHD
Moscow State Medical and Dental University named after A.I. Evdokimova of the Ministry of Health of the Russian Federation

Alexander Govorov, PHD
Moscow State Medical and Dental University named after A.I. Evdokimova of the Ministry of Health of the Russian Federation

Konstantin Skrupskiy, MD
Moscow State Medical and Dental University named after A.I. Evdokimova of the Ministry of Health of the Russian Federation

Dmitry Pushkar, PHD
Moscow State Medical and Dental University named after A.I. Evdokimova of the Ministry of Health of the Russian Federation