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Review
. 2017 Jun 29;6(6):CD007387.
doi: 10.1002/14651858.CD007387.pub4.

Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in women with gynaecological malignancies

Kittipat Charoenkwan  1 , Chumnan Kietpeerakool
Affiliations
Review

Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in women with gynaecological malignancies

Kittipat Charoenkwan et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an updated version of an original Cochrane review published in Issue 6, 2014. Pelvic lymphadenectomy is associated with significant complications including lymphocyst formation and related morbidities. Retroperitoneal drainage using suction drains has been recommended as a method to prevent such complications. However, findings from recent studies have challenged this policy.

Objectives: To assess the effects of retroperitoneal drainage versus no drainage after pelvic lymphadenectomy on lymphocyst formation and related morbidities in women with gynaecological cancer.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2017) in the Cochrane Library, electronic databases MEDLINE (1946 to March Week 2, 2017), Embase (1980 to 2017 week 12), and the citation lists of relevant publications. We also searched the trial registries for ongoing trials on 20 May 2017.

Selection criteria: Randomised controlled trials (RCTs) that compared the effect of retroperitoneal drainage versus no drainage after pelvic lymphadenectomy in women with gynaecological cancer. Retroperitoneal drainage was defined as placement of passive or active suction drains in pelvic retroperitoneal spaces. No drainage was defined as no placement of passive or active suction drains in pelvic retroperitoneal spaces.

Data collection and analysis: We assessed studies using methodological quality criteria. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). We examined continuous data using mean difference (MD) and 95% CI.

Main results: Since the last version of this review, we have identified no new studies for inclusion. The review included four studies with 571 women. Regarding short-term outcomes (within four weeks after surgery), retroperitoneal drainage was associated with a comparable rate of overall lymphocyst formation when all methods of pelvic peritoneum management were considered together (2 studies; 204 women; RR 0.76, 95% CI 0.04 to 13.35; moderate-quality evidence). When the pelvic peritoneum was left open, the rates of overall lymphocyst formation (1 study; 110 women; RR 2.29, 95% CI 1.38 to 3.79) and symptomatic lymphocyst formation (2 studies; 237 women; RR 3.25, 95% CI 1.26 to 8.37) were higher in the drained group. At 12 months after surgery, the rates of overall lymphocyst formation were comparable between the groups (1 study; 232 women; RR 1.48, 95% CI 0.89 to 2.45; high-quality evidence). However, there was a trend toward increased risk of symptomatic lymphocyst formation in the group with drains (1 study; 232 women; RR 7.12, 95% CI 0.89 to 56.97; low-quality evidence).

Authors' conclusions: Placement of retroperitoneal tube drains has no benefit in the prevention of lymphocyst formation after pelvic lymphadenectomy in women with gynaecological malignancies. When the pelvic peritoneum is left open, the tube drain placement is associated with a higher risk of short- and long-term symptomatic lymphocyst formation. We found the quality of evidence using the GRADE approach to be moderate to high for most outcomes, except for symptomatic lymphocyst formation at 12 months after surgery, and unclear or low risk of bias.

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Conflict of interest statement

Kittipat Charoenkwan is a coauthor of the article 'A prospective randomised study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer', published in the Journal of Obstetrics and Gynaecology Research 2002;28(3):149‐53.

Chumnan Kierpeerakool: None known

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
PRISMA flow diagram.
1.1
1.1. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 1 Short‐term lymphocyst formation: both asymptomatic and symptomatic within 4 weeks after surgery.
1.2
1.2. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 2 Short‐term lymphocyst formation: symptomatic within 4 weeks after surgery.
1.3
1.3. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 3 Short‐term lymphocyst formation: both asymptomatic and symptomatic at 8 weeks after surgery.
1.4
1.4. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 4 Short‐term lymphocyst formation: both asymptomatic and symptomatic at 12 weeks after surgery.
1.5
1.5. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 5 Long‐term lymphocyst formation: both asymptomatic and symptomatic at 12 months after surgery.
1.6
1.6. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 6 Long‐term lymphocyst formation: symptomatic at 12 months after surgery.
1.7
1.7. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 7 Febrile morbidity.
1.8
1.8. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 8 Pelvic infection.
1.9
1.9. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 9 Wound infection.
1.10
1.10. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 10 Wound dehiscence.
1.11
1.11. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 11 Fistula.
1.12
1.12. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 12 Bowel obstruction.
1.13
1.13. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 13 Leg oedema.
1.14
1.14. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 14 Deep venous thrombosis.
1.15
1.15. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 15 Symptomatic ascites.
1.16
1.16. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 16 Blood transfusion.
1.17
1.17. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 17 Duration of surgery (minute).
1.18
1.18. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 18 Return of bowel sounds (day).
1.19
1.19. Analysis
Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 19 Hospital stay (day).
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Update of

References

References to studies included in this review

Benedetti‐Panici 1997 {published data only}
    1. Benedetti‐Panici P, Maneschi F, Butillo G, D'Andrea G, Palumbo VS, Conte M, et al. A randomized study comparing retroperitoneal drainage with no drainage after lymphadenectomy in gynecologic malignancies. Gynecologic Oncology 1997;65:478‐82. - PubMed
Franchi 2007 {published data only}
    1. Franchi M, Trimbos J, Zanaboni F, Velden J, Reed N, Coens C, et al. Randomised trial of drains versus no drains following radical hysterectomy and pelvic lymph node dissection: a European Organisation for Research and Treatment of Cancer‐Gynaecological Cancer Group (EORTC‐GCG) study in 234 patients. European Journal of Cancer 2007;43:1265‐8. - PubMed
Lopes 1995 {published data only}
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Srisomboon 2002 {published data only}
    1. Srisomboon J, Phongnarisorn C, Suprasert P, Cheewakriangkrai C, Siriaree S, Charoenkwan K. A prospective randomized study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer. Journal of Obstetrics and Gynaecology Research 2002;28(3):149‐53. - PubMed

References to studies excluded from this review

Bafna 2001 {published data only}
    1. Bafna UD, Umadevi K, Savitha M. Closed suction drainage versus no drainage following pelvic lymphadenectomy for gynecological malignancies. International Journal of Gynecological Cancer 2001;11:143‐6. - PubMed
Franchi 1997 {published data only}
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Jensen 1993 {published data only}
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Morice 2001 {published data only}
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Patsner 1999 {published data only}
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Yamamoto 2000 {published data only}
    1. Yamamoto R, Saitoh T, Kusaka T, Todo Y, Takeda M, Okamoto K, et al. Prevention of lymphocyst formation following systematic lymphadenectomy. Japanese Journal of Clinical Oncology 2000;30(9):397‐400. - PubMed

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References to other published versions of this review

Charoenkwan 2010
    1. Charoenkwan K, Kietpeerakool C. Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in patients with gynaecological malignancies. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD007387.pub2] - DOI - PubMed
Charoenkwan 2014
    1. Charoenkwan K, Kietpeerakool C. Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in patients with gynaecological malignancies. Cochrane Database of Systematic Reviews 2014, Issue 6. [DOI: 10.1002/14651858.CD007387] - DOI - PMC - PubMed

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