Risk factors of developing lymphogenic complications after radical prostatectomy with pelvic lymph node dissection

Introduction. Prostate cancer (PCa) is very common and real problem in oncourology. The main treatment for localized and locally advanced prostate cancer is radical prostatectomy (RP). Performing RP with pelvic lymph node dissection (PLND) in patients with intermediate and high cancer risk may be associated with an increased risk of developing lymphogenic complications, such as: lymphedema, prolonged lymphorrhea, and the formation of lymphatic cysts (LC). Purpose: to assess the impact of risk factors on the development of lymphogenic complications after RP with PLND. Materials and methods. From January 2017 to March 2020 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department were performed 203 RPs with PLND, of which retropubic RPs (RRP) without the formation of peritoneal flap in 101 patients, RRP with the formation of peritoneal flap in 51 patients, laparoscopic RP (LRP) also in 51 patients. All operations were performed by different surgeons. Univariate comparisons and multivariate logistic regression analysis were used to compare and define independent risk factors for lymphogenic complications. Results. 85 patients (41,9%) out of 203 developed lymphogenic complications, such as symptomatic LC developed in 13 (6,4%), and asymptomatic LC in 38 (18,7%), prolonged lymphorrhea was observed in 25 (12,3%), lymphedema in 9 patients (4,4%). The incidence of lymphogenic complications was higher in the group with RRP without the formation of peritoneal flap in 53 patients compared to RRP with the formation of a peritoneal flap in 18 patients and LRP in 14 patients (53 compared to 32; p=0,028). Extended PLND compared with standard PLND was also one of the risk factors for the development of lymphogenic complications (55 compared to 30; p<0,001). Patients with lymphogenic complications had a larger number of lymph nodes removed (17 compared to 13; p=0,004). Age, body mass index, prostate volume, pTN, Gleason score, time of surgery, blood loss during surgery, the presence or absence of percutaneous drainage did not show a significant statistical difference. In a multivariate analysis extended PLND, the number of lymph nodes removed, and RRP without the formation of peritoneal flap remained the independent predictors of lymphogenic complications. Conclusions. In our study, RRP without the formation of peritoneal flap, extended PLND, and the number of lymph nodes removed, are significantly associated with a high risk of developing lymphogenic complications.

lymphatic cysts, lymphorrhea, radical prostatectomy, pelvic lymph node dissection, peritoneal flap