An analysis of the risk factors and management of lymphocele after pelvic lymphadenectomy in patients with gynecologic malignancies

Abstract

Objectives: The incidence and risk factors of lymphocele development after pelvic lymphadenectomy were evaluated and its management investigated.

Materials and methods: This retrospective study was carried out on 264 patients who received a pelvic lymphadenectomy, between March 1999 and February 2003, due to gynecologic cancer. The patients were classified into two groups; the lymphocele (n=50) and non-lymphocele groups (n=214), as confirmed by ultrasonography, CT scan and MRI. Each group was compared by cancer type and stage, BMI, preoperative Hb, use of pre/postoperative chemotherapy or radiotherapy, number of resected pelvic lymph nodes and the volume of postoperative drainage from a Hemovac pelvic drain.

Results: Of the 264 patients tested, 15 of 105 cervical cancer (14%), 22 of 115 ovarian cancer (19%) and 11 of 40 endometrial cancer patients (27%), a total of 50 patients (18%), developed lymphoceles. In the lymphocele group (n=50), 13 patients were diagnosed with complicated lymphocele. The BMI and number of resected pelvic lymph nodes were found to be higher in the lymphocele than in the non-lymphocele group (23.94+/-3.38 vs. 22.52+/-3.00, p=0.00 and 26.80+/-14.82 vs. 22.96+/-10.18, p=0.03, respectively), and showed statistical significance. The occurrence of lymphoceles was lower without postoperative radiotherapy (p=0.01).

Conclusion: Among the 264 patients, a total of 50 patients (18%) developed lymphoceles. The BMI and number of resected lymph nodes were higher in the lymphocele group, and the use of postoperative radiotherapy was associated with a higher risk of lymphoceles. Thirteen of the 50 patients that developed lymphoceles (n=50) required treatment for lymphocele-related complications.

Keywords: Lymphocele; Pelvic lymphadenectomy; Risk factors.

Fig. 1

Radiological examination showing lymphocele. (A) Ultrasonography revealed a thin-walled pelvic "cyst" (about 7×3 cm² sized). Lymphoceles were visualized as well-circumscribed oval structures. (B) CT findings of a smooth and thin-walled cavity (arrow) filled with a water-equivalent fluid, which was sharply demarcated from its surroundings, and showing no signs of infiltration were interpreted as lymphoceles. After ultrasonography-guided percutaneous catheter drainage, a catheter (arrow head) was inserted in the lymphocele cavity. (C) MRI revealed an about 7×3 cm² sized cyst, with low signal intensity on T1-W1.

Fig. 2

Fluoroscopy-guided percutaneous catheter drainage (after pelvic sonography). Arrow head; catheter

Fig. 3

Percutaneous catheter drainage. (A) Large (about 11×7 cm² sized) lymphocele were managed using sonography-guided placement of a percutaneous catheter, with drainage. The catheter (arrow head) is at the left, within the lymphocele. (B) Catheter drainage allowed complete radiological remission in this case. Arrow head; catheter.