engleski

PROPHYLACTIC PERITONEAL INCISION: PREVENTION OF LYMPHOCELES AFTER RETROPUBIC RADICAL PROSTATECTOMY ACCOMPANIED BY PELVIC LYMPHADENECTOMY

Background: High percentage of patients with prostate cancer undergo and benefit from retropubic radical prostatectomy (RRP). In some cases, RRP is accompanied by bilateral pelvic lymph node dissection (PLND). The most common complication after PNLD are lymphoceles, which are present in almost 50% of patients. However, only 3-9% of those are symptomatic and/or require intervention. Aim of our study was to determine the effect of so called „prophylactic peritoneal incision“ (PPI) on lymphocele incidence. Methods: This is a retrospective study of patients who underwent PPI after RRP and PNLD performed by a single-surgeon at the Department of Urology, CHC Rijeka from 2014 to 2016. The PPI is based on incision in peritoneal layer close to the internal iliac artery region with special emphasis on defining the course of ureter and avoiding it within secure distance. The same procedure was performed bilaterally, upon completion of the urethrovesical anastomosis and prior to insertion of a pelvic drain. We have analyzed hospital and ambulatory medical charts of investigated group. Reported symptoms, such as abdominal pain, leg pain, fever and lower limb edema, were evaluated. Ultrasound examination of the pelvis, looking specifically for lymphoceles, was performed one month after the surgery. Results: The investigated group constituted 36 patients. Median age was 68 years (range 52- 77 years). Mean preoperative PSA value was 37, 78 ng/mL (range 2, 33-243 ng/mL). Preoperative Gleason scores were: 6 (12, 9%), 7 (48, 4%), 8 (16, 1%), 9 (12, 9%), 10 ( 9.7%). Mean number of removed lymph nodes was 20 (range 8- 43). On first routine ambulatory check-up, no lymphoceles were detected on ultrasound examination in investigated group. In medical charts we have found inconsistently reported symptoms, so we will not make any conclusions on PPI impact on symptom rate. Conclusion: PPI leads to prevention of lymphocele formation. More objective diagnostic options (CT scans) should be considered in further investigation.

Prostate cancer ; Prophylactic peritoneal incision ; Lymphocele

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