Surgical strategies for lymphocele prevention in minimally-invasive radical prostatectomy and lymph-node dissection: a systematic review

PURPOSE: Pelvic lymph node dissection (PLND) is an important step during robotic radical prostatectomy (RARP). The collection of lymphatic fluid (lymphocele) is the most common complication with potentially severe impact; therefore different strategies have been proposed to reduce its incidence. MATERIAL AND METHODS: In this systematic review EMBASE, MEDLINE, Cochrane Library and NIH Registry of Clinical Trials were searched for papers including the following interventions: transperitoneal vs extraperitoneal approach, any reconfiguration of the peritoneum, the use of pelvic drains and the use of different sealing techniques and sealing agents. The outcome evaluated was the incidence of symptomatic lymphocele. Both randomized and non-randomized and/or retrospective studies. RESULTS: Twelve studies were included (including one ongoing RCT). Due to the heterogeneity of included studies no meta-analysis was performed. No significant impact was reported by different sealing techniques and agents or by surgical approach. Three retrospective, non-randomized studies showed a potential benefit of peritoneal reconfiguration in order to maximize the peritoneal surface of reabsorption. CONCLUSION: Lymphocele formation is a multi-step and multifactorial event, high quality literature analyzing risk factors and preventive measures is rather scarce. Peritoneal reconfiguration could represent a reasonable option that deserves further evaluation; no other preventive measure is supported by current evidence.