Lymphocele is an important condition commonly seen in the follow-up of patients who underwent radical prostatectomy and extended pelvic lymph node dissection (ePLND) for prostate cancer. Since the formation and treatment of lymphocele may have negative consequences in terms of patient-care and health expenditure. Several techniques have been used to prevent lymphocele. In this study, we aimed to investigate the efficacy of the previously described preventing lymphocele ensuring absorption transperitoneally (P.L.E.A.T.) technique and compare the outcomes of patients who underwent this technique.
Methodology:
The data of patients who underwent robot-assisted laparoscopic radical prostatectomy with ePLND for prostate cancer between 2017 and 2023 in our institution were retrospectively analyzed. Patients were divided into two groups according to the application of the P.L.E.A.T. technique in their operations. All patients were followed up with the same protocol. Patient characteristics and postoperative follow-up data were statistically analyzed.
Results:
Data of 78 patients (26 patients in the P.L.E.A.T. group and 52 patients in control group) were evaluated retrospectively. There were no statistically significant differences between the groups in terms of demographic and clinical characteristics, including age, prostate-specific antigen levels, body mass index, American Society of Anaesthesiologists score, D’Amico risk classification, or the number of lymph nodes removed. Analysis of postoperative data revealed statistically significant differences between the two groups in total amount of drainage (P < .05), drain removal day (P < .05), and length of hospital stay (P < .05).
Conclusions:
Our experience with the P.L.E.A.T. technique showed potential advantages in line with the literature, with a considerable reduction in total drain amount, drain removal day, and length of stay.
CornfordP, TilkiD, van den BerghRCN, et al.EAU – EANM – ESTRO – ESUR – ISUP – SIOG Guidelines on Prostate Cancer. Presented at the EAU Annual Congress Paris 2024. EAU Guidelines Office: Arnhem, The Netherlands; 2024. ISBN: 978-94-92671-23-3.
2.
D’AmicoAV, WhittingtonR, MalkowiczSB, et al.Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA, 1998; 280(11):969–974; doi: 10.1001/jama.280.11.969
3.
CooperbergMR, PastaDJ, ElkinEP, et al.The University of California, San Francisco Cancer of the Prostate Risk Assessment score: A straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy. J Urol, 2005; 173(6):1938–1942; doi: 10.1097/01.ju.0000158155.33890.e7
4.
PloussardG, BrigantiA, de la TailleA, et al.Pelvic lymph node dissection during robot-assisted radical prostatectomy: Efficacy, limitations, and complications—a systematic review of the literature. Eur Urol, 2014; 65(1):7–16; doi: 10.1016/j.eururo.2013.03.057
5.
Dal MoroF, ZattoniF. P.L.E.A.T.-Preventing lymphocele ensuring absorption transperitoneally: A robotic technique. Urology, 2017; 110:244–247; doi: 10.1016/j.urology.2017.05.031
6.
StolzenburgJU, ArthanareeswaranVKA, DietelA, et al.Four-point peritoneal flap fixation in preventing lymphocele formation following radical prostatectomy. Eur Urol Oncol, 2018; 1(5):443–448; doi: 10.1016/j.euo.2018.03.004i
7.
StudentV, TudosZ, StudentovaZ, et al.Effect of Peritoneal Fixation (PerFix) on lymphocele formation in robot-assisted radical prostatectomy with pelvic lymphadenectomy: Results of a randomized prospective trial. Eur Urol, 2023; 83(2):154–162; doi: 10.1016/j.eururo.2022.07.027
8.
SuS, WangJ, LeiY, et al.The efficacy of peritoneal flap fixation on symptomatic lymphocele formation following robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection: A systematic review and meta-analysis. Int J Surg, 2024; 110(2):1172–1182; doi: 10.1097/JS9.0000000000000893
9.
MayM, GilfrichC, BrundlJ, et al.Impact of peritoneal ınterposition flap on patients undergoing robot-assisted radical prostatectomy and pelvic lymph node dissection: A systematic review and meta-analysis of randomized controlled trials. Eur Urol Focus, 2024; 10(1):80–89; doi: 10.1016/j.euf.2023.07.007
10.
LeeM, LeeZ, EunDD. Utilization of a peritoneal ınterposition flap to prevent symptomatic lymphoceles after robotic radical prostatectomy and bilateral pelvic lymph node dissection. J Endourol, 2020; 34(8):821–827; doi: 10.1089/end.2020.0073
GlogerS, UbrigB, BoyA, et al.Bilateral peritoneal flaps reduce ıncidence and complications of lymphoceles after robotic radical prostatectomy with pelvic lymph node dissection-results of the prospective randomized multicenter Trial ProLy. Reply. J Urol, 2023; 209(1):76–77; doi: 10.1097/JU.0000000000002999
13.
GamalA, MoschovasMC, JaberAR, et al.Peritoneal flap following lymph node dissection in robotic radical prostatectomy: A novel “Bunching” Technique. Cancers (Basel), 2024; 16(8):1547; doi: 10.3390/cancers16081547
14.
DitonnoF, ManfrediC, FrancoA, et al.Impact of peritoneal reconfiguration on lymphocele formation after robot-assisted radical prostatectomy with pelvic lymph node dissection: A systematic review and meta-analysis of randomized controlled trials. Prostate Cancer Prostatic Dis, 2024; 27(4):635–644; doi: 10.1038/s41391-023-00744-5
BrigantiA, LarcherA, AbdollahF, et al.Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: The essential importance of percentage of positive cores. Eur Urol, 2012; 61(3):480–487; doi: 10.1016/j.eururo.2011.10.044
17.
GandagliaG, PloussardG, ValerioM, et al.A novel nomogram to ıdentify candidates for extended pelvic lymph node dissection among patients with clinically localized prostate cancer diagnosed with magnetic resonance ımaging-targeted and systematic biopsies. Eur Urol, 2019; 75(3):506–514; doi: 10.1016/j.eururo.2018.10.012
18.
TikkinenKAO, CartwrightR, GouldMK, et al.EAU Guidelines on Thromboprophylaxis in Urological Surgery. In: Presented at the EAU Annual Congress Amsterdam 2022. EAU Guidelines Office: Arnhem, The Netherlands; 2022. ISBN: 978-94-92671-16-5.
19.
KimJK, JeongYY, KimYH, et al.Postoperative pelvic lymphocele: Treatment with simple percutaneous catheter drainage. Radiology, 1999; 212(2):390–394; doi: 10.1148/radiology.212.2.r99au12390
20.
BoğaMS, SönmezMG, KaramıkK, et al.The effect of peritoneal re-approximation on lymphocele formation in transperitoneal robot-assisted radical prostatectomy and extended pelvic lymphadenectomy. Turk J Urol, 2020; 46(6):460–467; doi: 10.5152/tud.2020.20255
21.
BoganiG, BorghiC, DittoA, et al.Impact of surgical route in ınfluencing the risk of lymphatic complications after ovarian cancer staging. J Minim Invasive Gynecol, 2017; 24(5):739–746; doi: 10.1016/j.jmig.2017.03.014
22.
BrundlJ, LenartS, StojanoskiG, et al.Peritoneal flap in robot-assisted radical prostatectomy. Dtsch Arztebl Int, 2020; 117(14):243–250; doi: 10.3238/arztebl.2020.0243
23.
PoseRM, KnipperS, BeyerB, et al.Impact of peritoneal bladder flap in robot-assisted radical prostatectomy patients on lymphoceles: A prospective randomised trial. World J Urol, 2025; 43(1):148; doi: 10.1007/s00345-025-05518-3
24.
NeubergerM, KowalewskiKF, SimonV, et al.Peritoneal flap for lymphocele prophylaxis following robotic-assisted radical prostatectomy with lymph node dissection: The randomised controlled Phase 3 PELYCAN Trial. Eur Urol Oncol, 2024; 7(1):53–62; doi: 10.1016/j.euo.2023.07.009
25.
WagnerJ, McLaughlinT, PintoK, et al.The effect of a peritoneal ıliac flap on lymphocele formation after robotic radical prostatectomy: Results from the PLUS Trial. Urology, 2023; 173:104–110; doi: 10.1016/j.urology.2022.12.002
26.
DeutschS, HadaschikB, LebentrauS, et al.Clinical ımportance of a peritoneal ınterposition flap to prevent symptomatic lymphoceles after robot-assisted radical prostatectomy and pelvic lymph node dissection: A systematic review and meta-analysis. Urol Int, 2022; 106(1):28–34; doi: 10.1159/000512960
27.
Hinojosa-GonzalezDE, SaffatiG, KronstedtS, et al.Comparison of peritoneal interposition flaps and sealants for prevention of lymphocele after robotic radical prostatectomy and pelvic lymph node dissection: A systematic review, meta-analysis, Bayesian network meta-analysis, and meta-regression. J Robot Surg, 2024; 18(1):177; doi: 10.1007/s11701-024-01918-6
28.
EstevezA, BansalUK, WagnerJR, et al.The association of a peritoneal ınterposition flap with lymphocele formation after pelvic lymph node dissection during robotic-assisted laparoscopic radical prostatectomy: A systematic review and meta-analysis. Urology, 2024; 186:83–90; doi: 10.1016/j.urology.2024.01.014
29.
TatenumaT, EbaraS, KawaseM, et al.Association of hospital volume with perioperative and oncological outcomes of robot-assisted laparoscopic radical prostatectomy: A retrospective multicenter cohort study. BMC Urol, 2023; 23(1):14; doi: 10.1186/s12894-023-01178-w
