Stolzenburg, Jens-Uwe and Wasserscheid, Johanna and Rabenalt, Robert and Do, Minh and Schwalenberg, Thilo and McNeill, Alan and Constantinides, Costantinos and Kallidonis, Panagiotis and Ganzer, Roman and Liatsikos, Evangelos (2008) Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and pelvic lymph node dissection by bilateral peritoneal fenestration. WORLD JOURNAL OF UROLOGY, 26 (6). pp. 581-586. ISSN 0724-4983, 1433-8726
Full text not available from this repository. (Request a copy)Abstract
In our series of 1,900 endoscopic extraperitoneal radical prostatectomies (EERPE) the incidence of symptomatic lymphocele following simultaneous pelvic lymph node dissection (PLND) is between 3 and 14% depending on the extent of lymph node dissection. We report the impact of bilateral peritoneal fenestration after completion of extraperitoneal prostatectomy and PLND on the incidence of lymphocele, postoperative pain and complications. A total of 100 consecutive patients undergoing EERPE and extended PLND were allocated into two groups. In Group A (n = 50) a 4-6 cm incision was performed bilaterally over the external iliac vessels down to the obturator fossa after completion of the main procedure. In Group B (n = 50) no peritoneal incisions were made. The postoperative assessment protocol included a visual analogue pain scale administered three times daily for 6 days, analgesia requirement, and ultrasound examination on 4th and 8th days, and 3 months postoperatively. CRP and leucocyte counts were measured on 1st and 2nd postoperative days. Complications were recorded according to our standard protocol using the Clavien classification. Three patients (6%) in Group A were found to have lymphoceles, none of which were symptomatic. Significantly more patients in Group B developed a lymphocele, (n = 16, 32%, P < 0.001) of which a significant number were symptomatic (n = 7, 14%, P < 0.001) and required laparoscopic fenestration. No significant difference was observed between the pain score in either group. Mean pain scores were 3.4 versus 3.8 at 6 h, and 0.8 versus 1.1 at 6 days, respectively. No difference in analgesia requirement, serum inflammatory markers and return to normal bowel activity was observed between the groups. This study demonstrates that peritoneal fenestration significantly reduces the incidence of both symptomatic and asymptomatic lymphocele, without an increase in postoperative morbidity. As symptomatic lymphocele is one of the most common complications of extraperitoneal PLND requiring reintervention, we recommend that peritoneal fenestration should be performed routinely after extraperitoneal radical prostatectomy and PLND.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ENDOSCOPIC EXTRAPERITONEAL; RETROPUBIC PROSTATECTOMY; SINGLE-CENTER; CANCER; LYMPHADENECTOMY; COMPLICATIONS; EXPERIENCE; MORBIDITY; OUTCOMES; SURGERY; Fenestration; Laparoscopic; endoscopic; Prostatectomy; Lymphocele; Prostate cancer |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 19 Oct 2020 05:45 |
| Last Modified: | 19 Oct 2020 05:45 |
| URI: | https://pred.uni-regensburg.de/id/eprint/30031 |
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