CONTEXT: Symptomatic lymphocele (sLC) occurs at a frequency of 2-10% after robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND). Construction of bilateral peritoneal interposition flaps (PIFs) subsequent to completion of RARP + PLND has been introduced to reduce the risk of lymphocele, and was initially evaluated on the basis of retrospective studies. OBJECTIVE: To conduct a systematic review and meta-analysis of only randomized controlled trials (RCTs) evaluating the impact of PIF on the rate of sLC (primary endpoint) and of overall lymphocele (oLC) and Clavien-Dindo grade ≥3 complications (secondary endpoints) to provide the best available evidence. EVIDENCE ACQUISITION: In accordance with the Preferred Reporting Items for Meta-Analyses statement for observational studies in epidemiology, a systematic literature search using the MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE databases up to February 3, 2023 was performed to identify RCTs. The risk of bias (RoB) was assessed using the revised Cochrane RoB tool for randomized trials. Meta-analysis used random-effect models to examine the impact of PIF on the primary and secondary endpoints. EVIDENCE SYNTHESIS: Four RCTs comparing outcomes for patients undergoing RARP + PLND with or without PIF were identified: PIANOFORTE, PerFix, ProLy, and PLUS. PIF was associated with odds ratios of 0.46 (95% confidence interval [CI] 0.23-0.93) for sLC, 0.51 (95% CI 0.38-0.68) for oLC, and 0.41 (95% CI 0.21-0.83) for Clavien-Dindo grade ≥3 complications. Functional impairment resulting from PIF construction was not observed. Heterogeneity was low to moderate, and RoB was low. CONCLUSIONS: PIF should be performed in patients undergoing RARP and simultaneous PLND to prevent or reduce postoperative sLC. PATIENT SUMMARY: A significant proportion of patients undergoing prostate cancer surgery have regional lymph nodes removed. This part of the surgery is associated with a risk of postoperative lymph collections (lymphocele). The risk of lymphocele can be halved via a complication-free surgical modification called a peritoneal interposition flap.

• MeSH
• Humans MeSH
• Lymph Node Excision adverse effects   methods   MeSH
• Lymphocele * epidemiology   etiology   surgery   MeSH
• Prostatic Neoplasms * pathology   MeSH
• Prostatectomy adverse effects   methods   MeSH
• Randomized Controlled Trials as Topic MeSH
• Robotics * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Review MeSH
• Systematic Review MeSH

Pooperační ranné komplikace revaskularizačních výkonů v tříslech zahrnují velmi často komplikace spojené s poraněním lymfatického systému jako lymfokélu a lymforheu s následnými lokálními infekčními komplikacemi hrozícími infekcí protetických štěpů. Prezentujeme kazuistiku úspěšného ošetření pooperační lymfokély s následnou lymfatickou píštělí a dehiscencí operační rány pomocí intranodální embolizace poraněné lymfatické uzliny tkáňovým lepidlem Histoacryl.

Early postoperative wound complications in revascularization procedures in the groin very often include complications associated with injury to the lymphatic system such as lymphocele and lymphorrhea with subsequent local infectious complications and the risk of infection of prosthetic grafts. We present a case report of successful treatment of postoperative lymphocele with subsequent lymphatic fistula and dehiscence of the surgical wound by intranodal embolization of the injured lymph node with Histoacryl tissue glue.

• MeSH
• Vascular Fistula therapy   MeSH
• Chronic Limb-Threatening Ischemia surgery   complications   MeSH
• Surgical Wound Dehiscence therapy   MeSH
• Humans MeSH
• Lymph Nodes surgery   diagnostic imaging   MeSH
• Lymphography methods   MeSH
• Lymphocele * diagnostic imaging   therapy   MeSH
• Postoperative Complications diagnostic imaging   therapy   MeSH
• Punctures methods   MeSH
• Aged MeSH
• Embolization, Therapeutic * methods   MeSH
• Tissue Adhesives therapeutic use   MeSH
• Vascular Grafting methods   adverse effects   MeSH
• Groin surgery   pathology   MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

BACKGROUND: Symptomatic lymphoceles present the most common complication of robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (ePLND). No surgical technique has so far shown success in reducing the incidence rate, but several retrospective studies have shown the beneficial effect of the fixation of the peritoneum. OBJECTIVE: To introduce a modification in the technique of fixing the peritoneum to the pubic bone and to confirm whether this intervention reduces the incidence of lymphoceles. DESIGN, SETTING, AND PARTICIPANTS: A prospective randomized (1:1) single-center one-sided blind study was conducted in patients with localized prostate cancer (cT1-2cN0M0) indicated for RARP with ePLND operated between December 2019 and June 2021. In the intervention group, the free flap of the peritoneum was fixed to the pubic bone. In the control group, the peritoneal flap was left free without fixation. SURGICAL PROCEDURE: In the intervention group, the free flap of the peritoneum was fixed to the pubic bone (PerFix) so that lateral holes were left, allowing drainage of lymph from the pelvis into the abdominal cavity, where it would be resorbed. The iliac vessels and obturator fossa remained uncovered by the peritoneum and the bladder. MEASUREMENTS: The primary objective was to evaluate the frequency of symptomatic lymphoceles during follow-up. The secondary endpoints were the radiological presence of lymphoceles on computed tomography of the pelvis carried out 6 wk after surgery, the volume of the lymphoceles, and the degree of severe (Clavien-Dindo ≥3) complications. RESULTS AND LIMITATIONS: Of the 260 randomized patients, 245 were evaluated in the final analysis-123 in the intervention and 122 in the control group. The median follow-up was 595 d. There were no differences between the groups regarding clinical and pathological variables. The median of 17 nodes removed was the same in both groups (p = 0.961). Symptomatic lymphoceles occurred in 17 patients (6.9%), while in the intervention group these were found in three (2.4%) versus 14 (11.5%) in the control group (p = 0.011). The number of radiologically detected asymptomatic lymphoceles did not differ (p = 0.095). There was no significant difference in lymphocele volume between the two groups (p = 0.118). The rate of serious complications (Clavien 3a and 3b) was 4.8% in the intervention group and 9.1% in the control group (p = 0.587). A multivariate logistic regression model of symptomatic lymphocele occurrence was created with significant factors: body mass index (odds ratio [OR] = 1.1, 95% confidence interval [CI] = [1.03, 1.26], p = 0.012) and intervention (OR = 4.6, 95% CI = [1.28, 16.82], p = 0.02). CONCLUSIONS: Fixation of the peritoneum (PerFix) reduced the incidence of symptomatic lymphoceles in RARP with ePLND. We found no difference in the frequency of asymptomatic lymphocele development. The volume of the detected lymphoceles was similar. PATIENT SUMMARY: In this study, we compared the rate of development of postoperative complications using the peritoneal fixation technique with that of a nonfixation control group for robot-assisted radical prostatectomy with extended pelvic lymphadenectomy. Fixation of the peritoneum should obviate the development of severe complications in the postoperative period.

• MeSH
• Humans MeSH
• Lymph Node Excision adverse effects   methods   MeSH
• Lymphocele * etiology   prevention & control   MeSH
• Prostatic Neoplasms * pathology   MeSH
• Pelvis pathology   MeSH
• Peritoneum pathology   surgery   MeSH
• Prospective Studies MeSH
• Prostatectomy adverse effects   methods   MeSH
• Retrospective Studies MeSH
• Robotic Surgical Procedures * adverse effects   methods   MeSH
• Robotics * MeSH
• Free Tissue Flaps * pathology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH

BACKGROUND: An ocular adnexal apocrine adenocarcinoma (OAAA) is an extremely rare, but potentially aggressive and life-threatening tumor with ill-defined management based only on recommendations from a limited number of reported cases. The development of cervical lymphocele following neck dissection is a very rare complication, but one with well established methods for prevention and treatment. Here we describe a previously unreported case of salvage surgery including neck dissection for OAAA in addition to an emergence of cervical lymphocele. A literature review of current knowledge on both pathological conditions is included. METHODS AND RESULTS: A 58-year-old man suffering from OAAA, previously treated with multiple eye-sparing excisions and adjuvant proton therapy, underwent salvage surgery for locoregional recurrence of the tumor. A partial orbitectomy with orbital exenteration, primary reconstruction and left-sided neck dissection was performed. The procedure was complicated by a cervical lymphocele resolved after the surgical therapy. The patient remained disease-free during the one-year follow-up. CONCLUSION: OAAA is a locally aggressive tumor with potential to local or distant metastatic spread. Whole-body staging, regular clinico-radiological follow-up and stage-dependent therapy with surgery as the first-choice treatment is required. A cervical lymphocele as a complication of especially left-sided neck dissection is managed with a conservative or surgical therapy according to the level of lymph leakage, extent and localization of lesions, presence of local or systemic disorders and the period from primary surgery.

• MeSH
• Adenocarcinoma * pathology   surgery   MeSH
• Neck Dissection adverse effects   methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Recurrence, Local MeSH
• Lymphocele * etiology   surgery   MeSH
• Breast Neoplasms * surgery   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH
• Review MeSH

Radikální prostatektomie (RP) s rozšířenou pánevní lymfadenektomií (ePLND) představuje standardní terapii středně a vysoce rizikového lokalizovaného karcinomu prostaty (PCa). Využití ePLND v poslední době narůstá díky provádění většího množství RP u agresivnějších nádorů. Jednou z častých komplikací této operace je vznik symptomatických lymfokél, který se udává až u 10 % operovaných. Dosud, i přes rozsáhlý výzkum, nebyla nalezena vhodná strategie, jak předejít této komplikaci. Jednou z potenciálně úspěšných intervencí se zdá být fixace volného listu peritonea při provádění transperitoneální RP. Několik retrospektivních klinických studií prokázalo snížení výskytu symptomatických lymfokél při fixování peritonea k měchýři nebo stěně pánve, čímž je ponechána mezera v peritoneu, která vytvoří cestu pro volný pohyb lymfy z pánevní oblasti do peritoneální dutiny a její následnou resorpci. Jediná dosud publikovaná randomizovaná studie však tuto hypotézu nepotvrdila. Cílem tohoto článku je představit přehled dosud publikovaných klinických studií zabývajících se fixací peritonea.

Radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND) is currently a standard of care of intermediate and high-risk localized prostate cancer (PCa). The utilization of ePLND is increasing due to stage migration towards more aggressive cancer. Symptomatic lymphoceles, with incidence ranging up to 10 %, are one of the most frequent complications of ePLND. No successful strategy on how to prevent their occurrence has been found so far. One of the promising interventions could be peritoneal flap fixation during transperitoneal RP. Several retrospective studies have shown a reduction in the incidence of symptomatic lymphocele. The peritoneum can be fixed to the urinary bladder or to the pelvic wall leaving a window in the peritoneum that presents a pathway that directs the lymphatic fluid out of the pelvis into the peritoneal cavity where it can be absorbed. The only randomized trial published so far, however, did not show any benefit. This article aims to present an overview of published clinical studies on the fixation of the peritoneum.

• Keywords
• fixace peritonea,
• MeSH
• Humans MeSH
• Lymph Node Excision * methods   adverse effects   MeSH
• Lymphocele * etiology   prevention & control   MeSH
• Prostatic Neoplasms surgery   MeSH
• Prostatectomy methods   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

INTRODUCTION: Cysts originating from cervical lymphatic ducts are very rare affections. However, they play an important role in the differential diagnosis of supraclavicular masses. The aetiology remains unclear. Practically all cases arise from the thoracic duct; those affecting the right lymphatic duct are encountered very exceptionally. CASE REPORT: In the presented case report of a right lymphatic duct cyst, we analyzed the possible reasons for the diametrically differing incidence of cysts arising from the thoracic duct and those related to the right lymphatic duct. DISCUSSION: The cysts manifest themselves clinically as an otherwise asymptomatic supraclavicular swelling. The diagnosis is based on imaging. High T-lymphocytes and triglyceride levels in an aspirate are pathognomonic. There is no uniform opinion on the therapy. The majority of authors recommend surgical removal. Lymphatic vessels entering the cyst must be intraoperatively ligated to prevent lymph leakage.

• MeSH
• Adult MeSH
• Neck MeSH
• Humans MeSH
• Lymphatic Vessels * MeSH
• Lymphocele * diagnosis   surgery   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Úvod: Symptomatická lymfokéla může významným způsobem negativně ovlivňovat funkci transplantované ledviny. Cílem naší práce bylo pětileté sledování nemocných, kteří podstoupili léčbu. Metody: Do souboru bylo zařazeno 50 nemocných, kteří byli léčeni pro symptomatickou lymfokélu. Retrospektivně jsme hodnotili demografická data, příčinu renálního selhání, indikaci k léčbě, provedenou terapii. Laboratorně byly hodnoceny hladiny kreatininu, celkové bílkoviny a albuminu. Celkové přežití pacientů a štěpů bylo hodnoceno Kaplan-Meierovými křivkami. Výsledky: Průměrný věk 50 nemocných (44% žen, 56% mužů) byl 51,5±11,8 roku, doba mezi transplantací a diagnózou lymfokély byla 12,8±21,5 měsíců. Průměrná velikost lymfokély byla 71±35mm. Příčina renálního selhání vlastních ledvin byla: glomerulonefritida (34 %), tubulointersticiální nefritida (30 %), polycystóza (24 %), diabetická nefropatie (10 %) a nefroskleróza (2 %). Indikace k léčbě byla: elevace sérového kreatininu (44 %), hydronefróza štěpu (38 %), hydronefróza štěpu s elevací kreatininu (8%), hydronefróza s infekcí (6 %) a infekce (4 %). Léčba byla provedena: otevřenou drenáží do peritonea (40 %), jednorázovou aspirací (26 %), zevní drenáží (18 %) a laparoskopickou drenáží do peritonea (16 %). Průměrná hladina kreatininu v době léčby, resp. v 60. měsíci byla, 231μmol/l, resp. 172 μmol/l, plasmatická hladina celkové bílkoviny byla 59g/l, resp. 69g/l, plasmatická hladina albuminu 36g/l, resp. 43g/l. Pětileté přežívání nemocných bylo 86% a přežívání štěpů 66%. Závěr: Adekvátní léčba symptomatické lymfokély vede ke stabilizaci funkce štěpu. Pokud je lymfokéla indikována k léčbě, je třeba ji provést co nejdříve, aby se předešlo vzniku fibrózních změn. Žádné úmrtí ani ztráta štěpu neměly přímou souvislost s léčbou lymfokély

Introduction: Symptomatic lymphocele could impair the function of a graft kidney. The aim of our research was to conduct a five-year follow-up after symptomatic lymphocele therapy. Methods: Overall 50 patients undergoing the therapy of symptomatic lymphocele were enrolled in the study cohort. Demographic data, renal failure causes, indication of therapy and lymphocele management were retrospectively evaluated. Laboratory tests were done to evaluate serum creatinine, total plasma protein and albumin levels. Survival rates of the patients and of the grafts were analysed using Kaplan-Meier curves. Results: The mean age of the 50 patients (44% females, 56% males) was 51.5±11.8 years, and the time between kidney transplantation and symptomatic lymphocele diagnosis was 12.8±21.5 months. Average lymphocele diameter was 71±35 mm. Causes of the native kidney failure were: glomerulonephritis (34%), tubulointerstitial nephritis (30%), polycystosis (24%), diabetic nephropathy (10%) and nephrosclerosis (2%). The therapy indications were: serum creatinine elevation (44%), graft hydronephrosis (38%), serum creatinine elevation associated with hydronephrosis (8%), infection associated with hydronephrosis (6%) and infection (4%). The lymphocele was managed by: open surgical intraperitoneal drainage (40%), percutaneous aspiration (26%), percutaneous long-term drainage (18%) and laparoscopic intraperitoneal drainage (16%). Mean serum creatinine levels at the time of the therapy and 60 months later were 231 μmol/L and 172 μmol/L, respectively; total plasma protein levels were 59 g/L and 69 g/L, respectively; albumin plasma levels were 36 g/L and 43 g/L, respectively. The five-year patient survival rate was 86% and the graft survival rate was 66%. Conclusion: Adequate management of symptomatic lymphocele stabilizes the graft function. If the post-transplant lymphocele is indicated for therapy, the therapy should be applied as soon as possible to prevent fibrous changes in the surrounding tissues. No patient death or graft loss had any direct relationship with lymphocele management.

• MeSH
• Drainage methods   MeSH
• Creatinine urine   MeSH
• Humans MeSH
• Lymphocele * diagnostic imaging   pathology   therapy   MeSH
• Postoperative Complications MeSH
• Graft Survival MeSH
• Retrospective Studies MeSH
• Kidney Transplantation * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVE: To describe the sonographic characteristics of a lymphocele after pelvic and/or paraaortic lymphadenectomy for gynecological malignancy, analyze and identify ultrasound characteristics related to the symptomatic and asymptomatic lymphoceles. MATERIALS AND METHODS: This is a retrospective analysis of ultrasound examination data collected consecutively in patients after pelvic and/or paraaortic lymphadenectomy in one institution. We recorded the number of lymphoceles, localization, size; ultrasound morphology following International Ovarian Tumor Analysis group classification and symptoms. RESULTS: We described and analyzed 227 lymphoceles (150 asymptomatic and 77 symptomatic) in 161 patients. The asymptomatic lymphocele is typically a thick-walled cystic lesion without vascularization, round and unilocular with anechoic or ground-glass content. The symptomatic lymphocele is typically an oval, or ovoid, unilocular lesion with low-level or anechoic content (ground glass content is unlikely to be present, p < 0.001) and the presence of debris and septations. The lymphocele size (p = 0.001), number of lymphoceles (>1) (p = 0.005), septa (p = 0.002), and debris (p < 0.001) were independent ultrasound features correlating to symptoms development. More than one lymphocele (p = 0.047), septations (p = 0.007) and presence of debris (p < 0.001) were independent ultrasound features correlated to infection. CONCLUSION: Ultrasound features of symptomatic and asymptomatic lymphocele differ. The clues for lymphocele differential diagnosis are the history of lymphadenectomy and the finding cystic lesion with typically ultrasound features of lymphocele, adjacent to great pelvic vessels. Unique ultrasound features of lymphocele may help to distinguish from tumor relapse, hematoma, abscess, seroma or urinoma.

• MeSH
• Asymptomatic Diseases MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Lymph Node Excision statistics & numerical data   MeSH
• Lymphocele diagnostic imaging   pathology   MeSH
• Genital Neoplasms, Female surgery   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Ultrasonography * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

The aim of the study was to evaluate the role of colloid osmotic pressure in post-transplant lymphocele pathogenesis. We have analyzed total plasmatic protein and albumin levels, and electrophoresis has been completed in blood samples before transplantation and in days 3 and 14 after transplantation in 50 patients with lymphocele (Lymphocele) and 198 patients without lymphocele (control), respectively. Colloid osmotic pressure (COP) was calculated according to the Hoefs formula. Statistically significant differences were confirmed in albumin levels (42.2 respectively 44.8 g/L) before transplantation (day 0); in total protein (52.5 resp. 55.5 g/L), in albumin (30.1 resp. 32.1 g/L), and COP (15.6 respectively 17.7 kPa) in day 3; and in total protein (52.8 resp. 58.9 g/L), in albumin (30.5 respectively 35.4 g/L), in COP (16.1 respectively 21.2 kPa) in day 14. A potentially critical albumin level was established in 44.1 g/L in the blood analyzed, but its sensitivity was only 62%. The main risk element for the lymphocele formation remains the surgeon's hand. We can proclaim the role of proteins and their COP in the post-transplant lymphocele formation as one of possible pathogenetic cofactors. It is responsible for the impaired mechanisms of the reabsorption the lymph back to the tissues. Better metabolic care could help to reduce incidence of this surgical complication.

• MeSH
• Adult MeSH
• Incidence MeSH
• Colloids metabolism   MeSH
• Blood Proteins metabolism   MeSH
• Middle Aged MeSH
• Humans MeSH
• Lymphocele blood   etiology   MeSH
• Osmotic Pressure MeSH
• Postoperative Complications epidemiology   etiology   MeSH
• Serum Albumin metabolism   MeSH
• Kidney Transplantation adverse effects   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

OBJECTIVE: To evaluate the efficacy of a collagen-fibrin patch for the prevention of symptomatic lymphoceles after pelvic lymphadenectomy in women with gynecologic malignancies. METHODS: In a multicenter, randomized, clinical trial, 164 women with pelvic lymphadenectomy were allocated either to bilateral pelvic application of two collagen-fibrin patches or no intervention. Main outcome was efficacy, defined as reduction of symptomatic lymphocele rate diagnosed within four weeks after surgery. Secondary outcomes were asymptomatic lymphoceles and subsequent interventions. Sample size was based on the assumption that application of a collagen-fibrin patch reduces the prevalence of symptomatic lymphoceles by at least 66%. The study was single-blinded, i.e., patients and primary outcome assessors, but not surgeons, were blinded to the treatment allocation. RESULTS: A total of 75 women were randomized to the intervention and 89 to the control group. All women received the allocated intervention. In total, 42 (27.4%) lymphoceles and 8 (5.2%) symptomatic lymphoceles were observed. Symptomatic lymphoceles were observed in 5/68 (7.4%) women in the intervention group and 3/85 (3.5%) women in the control group (p = 0.47). Asymptomatic lymphoceles were observed in 16 (23.5%) women in the intervention group compared to 18 (21.2%) in the control group (p = 0.85). In a multivariate logistic regression model, no independent risk factor for the development of a symptomatic lymphocele was ascertained. DISCUSSION: Intraoperative application of collagen-fibrin patches to the pelvic side walls does not reduce the incidence of symptomatic lymphoceles in women with gynecologic malignancies undergoing pelvic lymphadenectomy.

• MeSH
• Single-Blind Method MeSH
• Middle Aged MeSH
• Humans MeSH
• Lymph Node Excision adverse effects   methods   MeSH
• Lymphocele etiology   prevention & control   MeSH
• Genital Neoplasms, Female surgery   MeSH
• Postoperative Complications etiology   prevention & control   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH