title: The incidence and sequela of lymphocele formation after robot-assisted extended pelvic lymph node dissection.
abstract: OBJECTIVE
  To determine an accurate incidence of lymphocele formation and its sequela after robot-assisted radical prostatectomy (RARP) and extended lymph node dissection (eLND) in a contemporary prostate cancer cohort.
  
  
  METHODS
  Consecutive patients who underwent RARP and eLND and had a minimum follow-up of 3 months were included. All surgeries were performed by one surgeon via a transperitoneal approach, with patients uniformly receiving low-molecular-weight heparin. Patients were followed with serial ultrasonography (US) based on a predetermined schedule for lymphocele surveillance. Incidence and sequelae of lymphoceles were retrospectively assessed.
  
  
  RESULTS
  In all, 521 patients were analysed. The mean (sd) follow-up was 33.5 (22.8) months. Lymphocele developed in 9% and became symptomatic in 2.5%. All except one were detected at the 1-month postoperative US; however, 76% regressed by the 3-month US. If lymphocele persisted at 3 months, 64% developed symptoms associated with infection and required drainage. Having diabetes mellitus was significantly associated with a higher risk of developing an infected lymphocele. Other symptoms related to lymphocele were rare. Comparisons of patient characteristics between patients with and without lymphoceles did not show any significant prognostic indicators to predict the occurrence of lymphocele in neither univariate nor multivariate analysis in the present cohort.
  
  
  CONCLUSIONS
  The incidence of symptomatic lymphocele after transperitoneal RARP and eLND is rare. However, during follow-up, US imaging at 3 months after surgery appears advisable. If a lymphocele is detected at the 3-month follow-up US discussing percutaneous external drainage with the patient appears to be wise, as it may prevent the development of a symptomatic lymphocele in two-thirds of such patients.
authors.affiliation: Departments of Urology, Acibadem University, Istanbul, Turkey.
authors.forename: Mehmet Selcuk
authors.initials: MS
authors.lastname: Keskin
authors.affiliation: Departments of Urology, Acibadem University, Istanbul, Turkey.
authors.forename: Ömer Burak
authors.initials: ÖB
authors.lastname: Argun
authors.affiliation: Acibadem Taksim Hospital, Istanbul, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Öbek
authors.affiliation: Departments of Urology, Acibadem University, Istanbul, Turkey.
authors.forename: Ilter
authors.initials: I
authors.lastname: Tufek
authors.affiliation: Departments of Urology, Aile Hospital, Istanbul, Turkey.
authors.forename: Mustafa Bilal
authors.initials: MB
authors.lastname: Tuna
authors.affiliation: Departments of Urology, Acibadem University, Istanbul, Turkey.
authors.forename: Panogiotis
authors.initials: P
authors.lastname: Mourmouris
authors.affiliation: Department of Public Health, Cerrahpasa School of Medicine, Istanbul, Turkey.
authors.forename: Sarper
authors.initials: S
authors.lastname: Erdoğan
authors.affiliation: Departments of Urology, Acibadem University, Istanbul, Turkey.
authors.forename: Ali Rıza
authors.initials: AR
authors.lastname: Kural
mesh_terms: D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D008210:Lymphocele / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*
keywords: cancer; lymphocele; prostate; robot