title: A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer.
abstract: OBJECTIVE
  To identify the incidence of asymptomatic and symptomatic (i.e., causing pain, hydronephrosis, venous thrombosis, acute lymphedema of the lower or urinary urgency) lymphoceles, as well as risk factors for their development, through a prospective study of patients undergoing sole pelvic or combined pelvic and paraaortic lymphadenectomy for gynecological cancer.
  
  
  METHODS
  Patients with endometrial, ovarian or cervical cancer scheduled for sole pelvic or combined pelvic and paraaortic lymphadenectomy as a primary surgical treatment or salvage surgery for recurrence were enrolled at single institution from February 2006 to November 2010 and prospectively followed up with ultrasound.
  
  
  RESULTS
  Of 800 patients who underwent sole pelvic or combined pelvic and paraaortic lymphadenectomy for gynecological cancer, the overall incidence of lymphoceles was 20.2%, with symptomatic lymphoceles occurring in 5.8% of all patients. Lymphoceles are predominantly located on the left pelvic side wall. Lymphadenectomy in ovarian cancer, a higher number of lymph nodes obtained (>27), and radical hysterectomy in cervical cancer were found to be independent risk factors for the development of symptomatic lymphoceles.
  
  
  CONCLUSIONS
  The overall incidence of lymphocele development after lymphadenectomy for gynecological cancer remains high. However, the majority of lymphoceles are only incidental finding without clinical impact. A symptomatic lymphocele is an uncommon event, occurring in only 5.8% of patients. Symptomatic lymphoceles tend to develop earlier than asymptomatic. Although such risk factors are hard to avoid, patients known to be at an increased risk of developing symptomatic lymphoceles can be counseled appropriately and followed up for specific symptoms relating to lymphocele development.
authors.affiliation: Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine and General University Hospital, Apolinarska 18, Prague 128 00, Czech Republic. Electronic address: michal.zikan@lf1.cuni.cz.
authors.forename: Michal
authors.initials: M
authors.lastname: Zikan
authors.affiliation: Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine and General University Hospital, Apolinarska 18, Prague 128 00, Czech Republic.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fischerova
authors.affiliation: Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine and General University Hospital, Apolinarska 18, Prague 128 00, Czech Republic.
authors.forename: Ivana
authors.initials: I
authors.lastname: Pinkavova
authors.affiliation: Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine and General University Hospital, Apolinarska 18, Prague 128 00, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Slama
authors.affiliation: Faculty of Medicine, Department of Obstetrics and Gynecology, Masaryk University, Obilni trh 526/11, Brno 602 00, Czech Republic.
authors.forename: Vit
authors.initials: V
authors.lastname: Weinberger
authors.affiliation: Institute of Biostatistics and Analyses, Masaryk University, Kamenice 126/3, Brno 625 00, Czech Republic.
authors.forename: Ladislav
authors.initials: L
authors.lastname: Dusek
authors.affiliation: Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine and General University Hospital, Apolinarska 18, Prague 128 00, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Cibula
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects / Q000706:statistics & numerical data*; D008210:Lymphocele / Q000453:epidemiology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Lymphocele; Paraaortic lymphadenectomy; Pelvic lymphadenectomy; Radical hysterectomy