Predictors of lymphocyst development following lymphadenectomy in patients with gynecologic cancer

To evaluate the incidence of lymphocyst formation in patients undergoing pelvic and/or para-aortic lymphadenectomy for gynecologic malignancies and identify associated factors.

A retrospective analysis was performed on 614 patients who underwent lymphadenectomy for primary endometrial, ovarian, or cervical cancer at Hacettepe University between 2014 and 2019.

Of the 614 patients, 276 (45%) had endometrial cancer, 262 (42.6%) had ovarian cancer, and 76 (12.4%) had cervical cancer. Postoperative lymphocyst formation occurred in 187 patients (30.5%), predominantly in the pelvic region (91.4%). Lymphocyst incidence was not significantly influenced by primary cancer type. Factors such as age, menopausal status, the extent of surgery and the use of pelvic drains or absorbable hemostats did not significantly affect lymphocyst formation. However, para-aortic lymphadenectomy, neoadjuvant therapy, adjuvant therapy, and the number of lymph nodes removed were identified as significant factors contributing to the development of lymphocysts. In multivariate analysis, only para-aortic lymphadenectomy (OR 2.17, 95% CI: 1.26-3.73) and neoadjuvant therapy (OR 2.31, 95% CI: 1.28-4.19) were found to be independent parameters associated with lymphocyst development. Symptomatic or complicated lymphocysts requiring intervention occurred in 16 patients (8.6%), representing 2.6% of the total patient cohort. The most common reason for intervention was infection within the lymphocyst.

Lymphocyst formation is a frequent complication following gynecologic cancer surgery, often remaining asymptomatic and detected incidentally during routine follow-ups. Lymphocysts are generally not a cause for concern, but they can lead to complications like infection, which requires intervention.