Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
BJU Int. 2021 Dec;128(6):728-733. doi: 10.1111/bju.15497. Epub 2021 Jun 9.
To reduce the risk of symptomatic lymphocele (SLC), we present a technique using peritoneal fenestration that allows lymphatic fluid to drain into the abdomen, as SLC formation after open retropubic radical prostatectomy (ORP) with pelvic lymph node dissection (PLND) is a common adverse event.
We identified 1513 patients who underwent ORP with PLND between July 2018 and November 2019. Of those, 307 patients (20.3%) received peritoneal fenestration and 1206 (79.7%) no fenestration. The rate of LCs and the necessity for intervention were analysed by uni- and multivariable logistic regression (MLR) models. A propensity score matching was performed, as well.
The median (interquartile range [IQR]) age was 65 (60-70) years. A median (IQR) of 16 (10-22) lymph nodes were dissected, 22 vs 14 lymph nodes in the fenestration vs non-fenestration group (P < 0.001). Overall, 189 patients (12.5%) were diagnosed with a LC after ORP, while 21 patients (6.8%) in the fenestration and 168 (13.9%) in the non-fenestration group had LCs (P = 0.001). In 70 patients (4.7%), LCs required further intervention, categorised as Clavien-Dindo Grade IIIa/b, with a smaller proportion in the fenestration group (2.9% vs 5.0% in the non-fenestration group, P < 0.001). There were no Clavien-Dindo Grade IV or V complications, in particular no abdominal complications in association with peritoneal fenestration observed. In MLR, peritoneal fenestration was associated with a reduced risk of LCs (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.2-0.5; P < 0.001). The risk reduction was also shown after propensity score matching (OR 0.38, 95% CI 0.21-0.68; P = 0.001). The number needed to treat was 14.
Peritoneal fenestration may decrease the rate of SLC after ORP with (extended) PLND. Therefore, it should be part of the operative strategy.
为降低有症状淋巴囊肿（SLC）的风险，我们提出了一种使用腹膜开窗的技术，使淋巴液能够排入腹腔，因为开放耻骨后根治性前列腺切除术（ORP）联合盆腔淋巴结清扫术（PLND）后形成 SLC 是一种常见的不良事件。
我们确定了 1513 名于 2018 年 7 月至 2019 年 11 月期间接受 ORP 联合 PLND 的患者。其中，307 名患者（20.3%）接受了腹膜开窗术，1206 名患者（79.7%）未接受腹膜开窗术。通过单变量和多变量逻辑回归（MLR）模型分析淋巴管囊肿的发生率和干预的必要性。还进行了倾向评分匹配。
中位（四分位距[IQR]）年龄为 65（60-70）岁。中位（IQR）切除 16（10-22）个淋巴结，开窗组 22 个，非开窗组 14 个（P<0.001）。总体而言，189 名患者（12.5%）在 ORP 后被诊断为淋巴管囊肿，而开窗组 21 名（6.8%）和非开窗组 168 名（13.9%）患者有淋巴管囊肿（P=0.001）。70 名患者（4.7%）需要进一步干预淋巴管囊肿，分为 Clavien-Dindo 分级 IIIa/b，开窗组比例较小（2.9%比非开窗组 5.0%，P<0.001）。没有 Clavien-Dindo 分级 IV 或 V 级并发症，特别是与腹膜开窗术相关的没有腹部并发症。在 MLR 中，腹膜开窗与降低淋巴管囊肿的风险相关（比值比[OR]0.33，95%置信区间[CI]0.2-0.5；P<0.001）。在倾向评分匹配后也显示了风险降低（OR 0.38，95%CI 0.21-0.68；P=0.001）。需要治疗的患者人数为 14 人。
腹膜开窗术可能降低 ORP 联合（扩大）PLND 后 SLC 的发生率。因此，它应该成为手术策略的一部分。
