Presented by: Angela Estevez MD
Beth Israel Deaconess Medical Center

Introduction

The use of a peritoneal interposition flap (PIF) has been proposed as a promising technique to reduce the rate of lymphocele formation after pelvic lymph node dissection (PLND) in robotic-assisted laparoscopic radical prostatectomy (RARP). Herein, we conducted a systematic review and meta-analysis to evaluate the association of PIF with lymphocele formation and postoperative complications after RARP. 

Materials

We conducted a systematic search of MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials through January 18, 2023 with a professional librarian. Two investigators independently selected studies for inclusion. A random effects meta-analysis was then performed to evaluate the associations of PIF with the following outcomes: symptomatic/asymptomatic lymphocele and non-lymphocele postoperative complications. 

Results

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Four randomized controlled trials (RCTs) and five retrospective studies, including 2,476 patients, were included in the final analysis. Compared to a standard technique, the use of PIF was associated with a reduced risk of 90-day symptomatic lymphocele formation after RARP when examining only RCTs (pooled OR 0.46, 95% CI 0.23-0.93; I² = 24%, Figure 1a) and both RCTs and observational studies (OR 0.37, 95% CI 0.18-0.74; I² = 43%, Figure 1b). Similarly, use of PIF was associated with a reduced risk of 90-day any lymphocele formation (OR 0.46, 95% CI 0.34-0.64, I²=4%; Figure 2). There were no statistically significant differences in postoperative complications (OR 0.98; 95% CI 0.73-1.32; I²=11%; Figure 3).  

Conclusion

Use of the PIF is associated with an approximately 50% reduced risk of symptomatic and any lymphocele formation within 90-days of surgery, and it is not associated with an increase of postoperative complications. 

Funding

None 

Lead Authors

Utsav Bansal, MD
Beth Israel Deaconess Medical Center

Co-Authors

Joseph Wagner, MD
Hartford Healthcare Medical Group

Sumedh Kaul, MS
Beth Israel Deaconess Medical Center

Aaron Fleishman, MPH
Beth Israel Deaconess Medical Center

Paul Bain, PHD
Countway Library, Harvard Medical School

Peter Chang, MD, MPH
Beth Israel Deaconess Medical Center

Andrew A. Wagner, MD
Beth Israel Deaconess Medical Center

Boris Gershman, MD
Beth Israel Deaconess Medical Center