Predictors of symptomatic lymphocele after lymph node excision and radical prostatectomy

To identify the prognostic factors of symptomatic lymphocele.

From January 2004, 359 patients underwent pelvic lymph node excision during radical prostatectomy at our center, of whom, 347 were followed up for > or = 6 months.

At a median follow-up of 14.5 months (range 6-54), 44 patients had developed a lymphocele (12.6%). In 26 patients (7.4%), it was symptomatic and required treatment. On univariate analysis, lymphocele was associated with the extension of the lymph node dissection, the number of nodes retrieved, and the presence of nodal metastasis. Patient age, year of surgery, surgeon, anticoagulant or antiplatelet oral therapy before and after the period of low-molecular-weight heparin prophylaxis, American Society of Anesthesiologists score, use of neoadjuvant hormonal therapy, preoperative prostate-specific antigen value, Gleason score, and pathologic stage were not influential. After adjusting for covariates, logistic regression analysis revealed that only the number of nodes was significantly associated with the onset of a symptomatic lymphocele. The risk of lymphocele seemed to increase linearly with the number of nodes retrieved, and the incidence of positive nodes reached a plateau when >10-13 nodes were harvested.

The benefit of more extensive nodal excision during radical prostatectomy should be weighed against the increased risk of lymphocele and its sequelae, including reintervention. In our series, no other factor, including previous anticoagulant or antiplatelet therapy, neoadjuvant hormonal therapy, and surgeon experience, influenced the incidence of symptomatic lymphocele.