Abstract
Introduction
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.
Patients and methods
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
References
Rassweiler J, Schulze M, Teber D, Seemann O, Frede T (2004) Laparoscopic radical prostatectomy: functional and oncological outcomes. Curr Opin Urol 14:75
Anastasiadis AG, Salomon L, Katz R, Hoznek A, Chopin D, Abbou C (2003) Radical retropubic versus laparoscopic prostatectomy a prospective comparison of functional outcome. Urology 62:292
Brown JA, Garlitz C, Gomella LG, Hubosky SG, Diamond SM, McGinnis D, Strup SE (2003) Pathologic comparison of laparoscopic versus open radical retropubic prostatectomy specimens. Urology 62:481
Guillonneau B, El-Fettouh H, Baumert H, Cathelineau X, Doublet JD, Fromont G, Vallancien G (2003) Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases at Montsouris Institute. J Urol 169:126
Steinberg AP, Gill IS (2004) Laparoscopic prostatectomy: a promising option in the treatment of prostate cancer. Cleve Clin J Med 71:78
Vallancien G, Cathelineau X, Baumert H, Doublet JD, Guillonneau B (2002) Complications of transperitoneal laparoscopic surgery in urology: review of 1,311 procedures at a single center. J Urol 168:23
Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD, Baumert H, Vallancien G (2002) Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol 167:51
Stolzenburg JU, Rabenalt R, Do M, Truss MC, Burchardt M, Hermann TR, Schwalwnberg T, Kallidonis P, Liatsikos EN (2007) Endoscopic extraperitoneal radical prostatectomy: the university of Leipzig experience of 1,300 cases. World J Urol 25:45–51
Stolzenburg JU, Liatsikos E, Rabenalt R (2006) Nerve sparing endoscopic radical prostatectomy—effect of puboprostatic ligament preservation on early continence and positive margins. Eur Urol 49:103–112
Stolzenburg JU, Rabenalt R, Do M et al (2006) Nerve–sparing endoscopic extraperitoneal radical prostatectomy: University of Leipzig technique. J Endourol 20:925–929
Stolzenburg JU, Rabenalt R, Tannapfel A, Liatsikos E (2006) Intrafascial nerve-sparing endoscopic radical prostatectomy. Urology 67:17–21
Remzi M, Klingler HC, Tinzl MV, Fong YK, Lobbe M, Kiss B, Marberger M (2005) Morbidity of laparoscopic extraperitoneal radical prostatectomy versus open retropubic radical prostatectomy. Eur Urol 48:83–89
Pineiro LM, Caceres F, Sanchez C, Tabernero A, Cansino JR et al (2006) Learning curve of laparoscopic radical prostatectomy in a University teaching hospital: experience after the first 600 cases. Eur Urol Suppl 5:914–924
Stolzenburg JU, Rabenalt R, Do M, Horn LC, Liatsikos EN (2006) Modular training for residents with no prior experience with open pelvic surgery in endoscopic extraperitoneal radical prostatectomy. Eur Urol 49:491–500
Stolzenburg JU, Rabenalt R, Do M, Lee B, Truss MC, Schwaibold H, Buchardt M et al (2006) Categorisation of complications of endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy. World J Urol 24:88–93
Gonzalgo ML, Pavlovich CP, Trock BJ, Link RE, Sullivan W, Su LM (2005) Classification and trends of perioperative morbidities following radical prostatectomy. J Urol 174:135–139. Discussion 139
Blana A, Straub M, Wild PJ, Lunz JC, Bach T, Wieland WF, Ganzer R (2007) Approach to endoscopic extraperitoneal radical prostatectomy (EERPE): the impact of previous laparoscopic experience on the learning curve. BMC Urol 7:11
Stolzenburg JU, Do M, Pfeiffer H, König F, Aedtner B, Dorschner W (2002) The endoscopic extraperitoneal radical prostatectomy (EERPE): technique and initial experience. World J Urol 20:48
Thiele R (2004) Die radikale retropubische prostatektomie—Goldstandard beim prostatakarzinom? Urologe A 43:38–42
Rassweiler J, Hruza M, Teber D, Su LM (2006) Laparoscopic and robotic assisted radical prostatectomy—critical analysis of the results. Eur Urol 49:612–624
Heidenreich A, Ohlmann CH, Polyakov S (2007) Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy. Eur Urol 52:29–37
Briganti A, Chun FK, Salonia A, Suardi N, Gallina A et al (2006) Complications and other outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol 50:1006–1013
Schumacher M, Burkhard FC, Studer UE (2005) The role of pelvic lymphadenectomy in clinically localised prostate cancer. Urologe A 44(6):645–651
Burkhard FC, Schumacher M, Studer UE (2005) The role of lymphadenectomy in prostate cancer. Nat Clin Pract Urol 2(7):336–342
Heidenreich A, Von Knobloch R, Varga Z et al (2004) Extended pelvic lymphadenectomy in men undergoing radical retropubic prostatectomy (RRP)—an update on >300 cases. J Urol 171(312):1183
Link RE, Morton RA (2001) Indications for pelvic lymphadenectomy in prostate cancer. Urol Clin North Am 28(3):491–498
Clark T, Parekh DJ, Cookson MS, Chang SS, Smith ER Jr, Wells N, Smith JA Jr (2003) Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol 169(1):145–148
Allaf ME, Partin AW, Carter BH (2006) The importance of pelvic lymph node dissection in men with clinically localized prostate cancer. Rev Urol 8(3):112–119
Solberg A, Angelsen A, Bergan U, Haugen OA, Viset T, Klepp O (2003) Frequency of lymphoceles after open laparoscopic pelvic lymph node dissection in patients with prostate cancer. Scand J Urol 37(3):218–221
Augustin H, Hammerer P, Graefen M, Palisaar J, Noldus J, Fernandez S, Huland H (2003) Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002. Eur Urol 43:113–118
Conflict of interest statement
There is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
J.-U. Stolzenburg and J. Wasserscheid have contributed equally to this work.
Rights and permissions
About this article
Cite this article
Stolzenburg, JU., Wasserscheid, J., Rabenalt, R. et al. Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and pelvic lymph node dissection by bilateral peritoneal fenestration. World J Urol 26, 581–586 (2008). https://doi.org/10.1007/s00345-008-0327-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-008-0327-3