R.M. Molchanov, E.V. Pilin, O.O. Goncharuk
Despite the proven importance of pelvic lymph node dissection during radical prostatectomy for staging the tumor process, it is associated with complications that lead to an increase in the length of hospitalization and treatment expenses. The goal of the study is to assess the experience of laparoscopic pelvic lymph node dissection and its complications from the point of view of modern ideas about their prevention, diagnosis and treatment.
The study included 104 patients aged 66,4±6,2 (M±Г) who had radical laparoscopic prostatectomy with extended lymphadenectomy. In 48 patients with the aim of preventing lymphocele, the formation of «windows» in the pelvic part of the parietal peritoneum was performed.
The main complication was lymphocele that developed in 19 (18,3%) patients along 3-11 weeks after the surgery. 16 lymphoceles were asymptomatic, their volume determined by ultrasound scanning was 72,1±16,9 ml. In 3 patients complained of pain in the iliac region, dysuria, asymmetry of the lower abdomen; lymphocele of volume more than 300 ml had been revealed. 5 patients underwent puncture, drainage of the lymphocele cavity with the instillation of doxycycline solution as a sclerosing agent. In 3 cases of symptomatic lymphocele, laparoscopic marsupialization was performed. The prophylactic formation of «windows» in 48 patients in the pelvic part of the parietal peritoneum resulted in a 3-fold decrease of lymphocele incidence.
Conclusions. Lymphocele is the most common complication of lymph node dissection (18,3%) with extraperitoneal access. The presence of connection of perivesical space with the abdominal cavity is a factor that reduces the risk of developing lymphocele. Improving the criteria for extended lymp node dissection radical prostatectomy is a promising way to reduce the incidence of postoperative complications.