Xue Zixuan, Yan Ye, Chen Huiying, Mao Hai, Ma Tianwu, Wang Guoliang, Zhang Hongxian, Ma Lulin, Ye Jianfei, Hong Kai, Zhang Fan, Zhang Shudong
Department of Urology, Peking University Third Hospital, Beijing, China.
Department of Radiology, Peking University Third Hospital, Beijing, China.
World J Surg Oncol. 2025 Jan 25;23(1):23. doi: 10.1186/s12957-025-03683-8.
Lymphatic leakage is a common complication after radical cystectomy and pelvic lymph node dissection (PLND) for muscle-invasive bladder cancer (MIBC).This study aimed to investigate the risk factors contributing to postoperative lymphatic leakage in patients with MIBC.
A total of 534 patients undergoing radical cystectomy and PLND were enrolled in the retrospective study at Peking University Third Hospital from January 2010 to July 2023. Patients were categorized into lymphatic leakage(n = 254)and non-leakage groups (n = 280) and compared demographic, perioperativ and pathologic factors. Multivariate logistic regression was applied to identify risk factors for lymphatic leakage. Spearman correlation was used to analyze the relationship between lymph leakage ratio and risk factors.
Patients with lymphatic leakage had significantly higher rates of receiving extended PLND (19.7% vs. 11.4%, p = 0.008), higher total number of dissected lymph nodes (median 11 vs. 8, p < 0.001), longer hospital stays (median 13 vs. 11 days, p < 0.001), higher postoperative hypoalbuminemia rate (56.7% vs. 36.4%, p < 0.001) and higher fever rate (14.2% vs. 8.6%, p = 0.04) compared to the non-leakage group. On multivariate analysis, higher number of dissected lymph nodes (OR 3.278, 95% CI 1.135-9.471, p = 0.028) was found to be a independent risk factor for lymphatic leakage. Additionally, a positive correlation was observed between the numbers of dissected lymph nodes and lymphatic leakage rate (R = 0.456, p = 0.013).
The increased number of dissected lymph nodes is associated with a heightened risk of lymphatic leakage following radical cystectomy for MIBC.
淋巴漏是肌层浸润性膀胱癌（MIBC）根治性膀胱切除术及盆腔淋巴结清扫术（PLND）后的常见并发症。本研究旨在探讨MIBC患者术后淋巴漏的危险因素。
2010年1月至2023年7月，北京大学第三医院对534例行根治性膀胱切除术及PLND的患者进行了回顾性研究。将患者分为淋巴漏组（n = 254）和无淋巴漏组（n = 280），比较两组患者的人口统计学、围手术期及病理因素。采用多因素logistic回归分析确定淋巴漏的危险因素。采用Spearman相关性分析淋巴漏发生率与危险因素之间的关系。
与无淋巴漏组相比，淋巴漏组患者接受扩大PLND的比例显著更高（19.7% 对11.4%，p = 0.008），清扫淋巴结总数更多（中位数11个对8个，p < 0.001），住院时间更长（中位数13天对11天，p < 0.001），术后低蛋白血症发生率更高（56.7% 对36.4%，p < 0.001），发热率更高（14.2% 对8.6%，p = 0.04）。多因素分析显示，清扫淋巴结数量较多（OR 3.278，95% CI 1.135 - 9.471，p = 0.028）是淋巴漏的独立危险因素。此外，清扫淋巴结数量与淋巴漏发生率呈正相关（R = 0.456，p = 0.013）。
MIBC根治性膀胱切除术后，清扫淋巴结数量增加与淋巴漏风险升高相关。
