Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany.
Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany.
Eur Urol Focus. 2024 Jan;10(1):80-89. doi: 10.1016/j.euf.2023.07.007. Epub 2023 Aug 3.
Symptomatic lymphocele (sLC) occurs at a frequency of 2-10% after robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND). Construction of bilateral peritoneal interposition flaps (PIFs) subsequent to completion of RARP + PLND has been introduced to reduce the risk of lymphocele, and was initially evaluated on the basis of retrospective studies.
To conduct a systematic review and meta-analysis of only randomized controlled trials (RCTs) evaluating the impact of PIF on the rate of sLC (primary endpoint) and of overall lymphocele (oLC) and Clavien-Dindo grade ≥3 complications (secondary endpoints) to provide the best available evidence.
In accordance with the Preferred Reporting Items for Meta-Analyses statement for observational studies in epidemiology, a systematic literature search using the MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE databases up to February 3, 2023 was performed to identify RCTs. The risk of bias (RoB) was assessed using the revised Cochrane RoB tool for randomized trials. Meta-analysis used random-effect models to examine the impact of PIF on the primary and secondary endpoints.
Four RCTs comparing outcomes for patients undergoing RARP + PLND with or without PIF were identified: PIANOFORTE, PerFix, ProLy, and PLUS. PIF was associated with odds ratios of 0.46 (95% confidence interval [CI] 0.23-0.93) for sLC, 0.51 (95% CI 0.38-0.68) for oLC, and 0.41 (95% CI 0.21-0.83) for Clavien-Dindo grade ≥3 complications. Functional impairment resulting from PIF construction was not observed. Heterogeneity was low to moderate, and RoB was low.
PIF should be performed in patients undergoing RARP and simultaneous PLND to prevent or reduce postoperative sLC.
A significant proportion of patients undergoing prostate cancer surgery have regional lymph nodes removed. This part of the surgery is associated with a risk of postoperative lymph collections (lymphocele). The risk of lymphocele can be halved via a complication-free surgical modification called a peritoneal interposition flap.
机器人辅助根治性前列腺切除术（RARP）+盆腔淋巴结清扫术（PLND）后，症状性淋巴囊肿（sLC）的发生率为 2-10%。在完成 RARP+PLND 后构建双侧腹膜间置皮瓣（PIF），已被引入以降低淋巴囊肿的风险，最初是基于回顾性研究进行评估的。
仅对评估 PIF 对 sLC 发生率（主要终点）和总淋巴囊肿（oLC）和 Clavien-Dindo 分级≥3 并发症（次要终点）影响的随机对照试验（RCT）进行系统评价和荟萃分析，以提供最佳现有证据。
根据观察性研究中荟萃分析的首选报告项目声明，使用 MEDLINE（PubMed）、Cochrane 对照试验中心注册库（CENTRAL）和 EMBASE 数据库，系统地检索了截至 2023 年 2 月 3 日的文献，以识别 RCT。使用修订后的 Cochrane 随机试验偏倚风险工具评估偏倚风险（RoB）。使用随机效应模型分析 PIF 对主要和次要终点的影响。
共确定了 4 项比较 RARP+PLND 患者接受或不接受 PIF 治疗的 RCT：PIANOFORTE、PerFix、ProLy 和 PLUS。PIF 与 sLC 的优势比（OR）为 0.46（95%置信区间 [CI] 0.23-0.93）、oLC 的 OR 为 0.51（95% CI 0.38-0.68）和 Clavien-Dindo 分级≥3 并发症的 OR 为 0.41（95% CI 0.21-0.83）。未观察到因构建 PIF 而导致的功能障碍。异质性为低至中度，RoB 为低。
在接受 RARP 和同时 PLND 的患者中应进行 PIF，以预防或减少术后 sLC。
前列腺癌手术的很大一部分患者会切除局部淋巴结。该手术部分与术后淋巴积聚（淋巴囊肿）的风险相关。一种称为腹膜间置皮瓣的无并发症手术改良可将淋巴囊肿的风险降低一半。
