Risk factors associated with postoperative lymphocele in patients with gynecological malignant tumors: a systematic...

Pelvic lymphoceles are a common complication after lymph node dissection for gynecological malignancies, with severe cases leading to significant morbidity and delays in adjuvant therapy. This meta-analysis aims to identify risk factors for postoperative lymphoceles and provide evidence for clinical prevention and management.

A systematic search was performed across eight databases (CNKI, Wanfang, VIP, CBM, Web of Science, PubMed, Cochrane Library, Embase) from inception to August 15, 2025, to include cohort and case-control studies. Two investigators independently screened studies and extracted data. Methodological quality was assessed using the Newcastle-Ottawa Scale, and statistical analyses were conducted with STATA 18.0. Meta-analysis employed fixed- or random-effects models, with heterogeneity evaluated by the I² statistic. The study was registered in PROSPERO (CRD420251053680).

64 studies involving 15,739 patients were included. The pooled incidence of postoperative lymphocele was 30.18%. Moderate to high between-study heterogeneity was detected for most outcomes. Key significant risk factors were as follows: age >50 years (OR = 1.21, 95%CI: 1.02-1.42), BMI ≥24 kg/m² (OR = 1.45, 95%CI: 1.10-1.93), diabetes mellitus (OR = 1.30, 95%CI: 1.11-1.52), laparotomy (OR = 2.76, 95%CI: 2.12-3.58), resection of >20 lymph nodes (OR = 2.75, 95%CI: 2.16-3.51), pelvic and para-aortic lymphadenectomy (OR = 1.86, 95%CI: 1.42-2.43), omentectomy (OR = 1.56, 95%CI: 1.18-2.07), retroperitoneal closure (OR = 2.44, 95%CI: 1.67-3.57), monopolar electrosurgery (OR = 2.48, 95%CI: 1.75-3.51), prolonged operation time (>3h) (OR = 1.56, 95%CI: 1.10-2.21), 24h drainage >100 ml (OR = 1.61, 95%CI: 1.10-2.36), prolonged drainage (>3d) (OR = 1.60, 95%CI: 1.03-2.46), transvaginal drainage (OR = 2.90, 95%CI: 1.92-4.40), ovarian cancer (OR = 1.69, 95%CI: 1.21-2.36), lymphovascular invasion (OR = 1.25, 95%CI: 1.03-1.52), deep myometrial invasion (OR = 1.89, 95%CI: 1.25-2.87), lymph node positivity (OR = 1.59, 95%CI: 1.26-2.00), anemia (OR = 1.20, 95%CI: 1.02-1.40), hypoalbuminemia (OR = 1.58, 95%CI: 1.07-2.34), postoperative chemotherapy (OR = 1.85, 95%CI: 1.29-2.65), and concurrent chemoradiotherapy (OR = 2.49, 95%CI: 1.68-3.69). Advanced FIGO stage was also significant.

Clinicians can stratify lymphocele risk by integrating preoperative features, surgical procedures, tumor pathology, nutritional status, and adjuvant therapy to guide individualized management. Intraoperatively, rational planning, limited lymphadenectomy, retroperitoneal preservation, and standardized use of energy devices are recommended. Postoperatively, optimized drainage and correction of nutritional disorders reduce lymphocele risk. Given heterogeneity in some risk factors and predominance of single-center retrospective studies, well-designed prospective studies with unified criteria are needed to validate and refine prevention strategies.

https://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD420251053680).