Department of Urology, University of Leipzig, Leipzig, Germany.
Department of Urology, University of Leipzig, Leipzig, Germany.
Eur Urol Oncol. 2018 Oct;1(5):443-448. doi: 10.1016/j.euo.2018.03.004. Epub 2018 May 15.
Symptomatic lymphocele following radical prostatectomy (RP) and concomitant bilateral extended pelvic lymph node dissection (ePLND) has a significant impact on postoperative recovery and may sometimes require surgical intervention.
To report on the use of four-point peritoneal flap fixation (4PPFF) during RP to reduce lymphocele occurrence following PLND.
DESIGN, SETTING, AND PARTICIPANTS: Between April 2010 and May 2017, 1358 patients underwent RP with concomitant bilateral ePLND. From this cohort, 193 patients who had undergone PNLD with 4PPFF were matched in a 1:1 ratio with respect to age, body mass index, initial PSA, and number of lymph nodes removed to patients who had undergone PLND without 4PPFF.
4PPFF was performed by suturing the cut end of the ventral parietal peritoneum at four points (to the anterior and lateral pelvic side wall on both sides) following PLND so that the peritoneal surface was exposed to the iliac vessels and obturator fossa.
All patients underwent ultrasound on postoperative days 6, 28, and 90 to test for the presence of lymphocele. For univariate analysis, a χ test and analysis of variance were applied, as appropriate. Statistical significance was set at p<0.05, and all p values reported were two-sided.
There were no significant differences between the two groups with respect to intraoperative blood loss, positive surgical margin rate, Gleason score, clinical stage, and number of positive cores. Asymptomatic lymphocele was observed in four patients (2.07%) in the 4PPFF group compared to 16 patients (8.3%) without 4PPFF (p=0.0058). Similarly, a significant difference in the incidence of symptomatic lymphocele was observed: two patients (1.03%) in the 4PPFF group versus nine patients (4.6%) without 4PPFF (p=0.0322). There were no differences in other complication rates between the two groups. The limitations of the study are its retrospective and nonrandomised nature, with postoperative follow-up based on ultrasound imaging rather than computed tomography because of ethical considerations, which could have caused observer bias.
4PPFF is a safe and effective procedure in preventing lymphocele occurrence in patients undergoing RP with PLND. The increase in exposure of the PLND raw area to the peritoneal surface following this procedure may aid in increased absorption of accumulating lymph fluid. Further prospective randomised multicentre studies are warranted to confirm our observations.
We report on the use of a surgical technique to decrease the collection of lymphatic fluid in the abdominal cavity following lymph node removal during radical removal of the prostate gland in patients with prostate cancer. Patients undergoing this procedure had significantly better outcomes when compared to patients operated on in the conventional approach.
根治性前列腺切除术（RP）和双侧广泛盆腔淋巴结清扫术（ePLND）后出现症状性淋巴囊肿会显著影响术后恢复，有时可能需要手术干预。
报告在 RP 中使用四点腹膜瓣固定术（4PPFF）以降低 PLND 后淋巴囊肿的发生。
设计、设置和参与者：2010 年 4 月至 2017 年 5 月，1358 例患者接受了 RP 联合双侧 ePLND。从该队列中，按照年龄、体重指数、初始 PSA 和切除的淋巴结数量，将 193 例接受 PNLD 伴 4PPFF 的患者与未行 4PPFF 的 PLND 患者 1:1 匹配。
在 PLND 后，通过缝合腹侧壁腹膜的四个点（两侧骨盆侧壁的前侧和外侧）进行 4PPFF，使腹膜表面暴露于髂血管和闭孔窝。
所有患者在术后第 6、28 和 90 天接受超声检查，以检测淋巴囊肿的存在。对于单变量分析，适当应用 χ 检验和方差分析。统计学意义设定为 p<0.05，所有报告的 p 值均为双侧。
两组在术中失血量、切缘阳性率、Gleason 评分、临床分期和阳性核心数方面无显著差异。4PPFF 组有 4 例（2.07%）出现无症状性淋巴囊肿，而无 4PPFF 组有 16 例（8.3%）（p=0.0058）。同样，症状性淋巴囊肿的发生率也有显著差异：4PPFF 组 2 例（1.03%），无 4PPFF 组 9 例（4.6%）（p=0.0322）。两组其他并发症发生率无差异。该研究的局限性在于其回顾性和非随机性质，以及由于伦理考虑，术后随访基于超声成像而不是计算机断层扫描，这可能导致观察者偏倚。
在接受 PLND 的 RP 患者中，4PPFF 是一种安全有效的预防淋巴囊肿发生的方法。该手术增加了 PLND 裸露区域与腹膜表面的接触，可能有助于增加积聚的淋巴液的吸收。需要进一步进行前瞻性随机多中心研究来证实我们的观察结果。
我们报告了一种手术技术的使用，该技术可减少前列腺癌患者接受根治性前列腺切除和淋巴结清扫术后腹腔内淋巴液的积聚。与接受传统手术的患者相比，接受该手术的患者有更好的结果。
