Cancer Res Treat.  2004 Dec;36(6):377-383.

An Analysis of the Risk Factors and Management of Lymphocele after Pelvic Lymphadenectomy in Patients with Gynecologic Malignancies

• Kim HY
• Kim JW
• Kim SH
• Kim YT
• Kim JH

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(R) 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.

Keyword

Lymphocele; Pelvic lymphadenectomy; Risk factors

MeSH Terms

Drainage
Drug Therapy
Endometrial Neoplasms
Female
Humans
Incidence
Lymph Node Excision*
Lymph Nodes
Lymphocele*
Magnetic Resonance Imaging
Ovarian Neoplasms
Radiotherapy
Retrospective Studies
Risk Factors*
Tomography, X-Ray Computed
Ultrasonography
Uterine Cervical Neoplasms

Figure

• 

  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.

Reference

1. Mori N. Clinical and experimental studies on the so-called lymphocyst which develops after radical hysterectomy in cancer of the uterine cervix. J Jpn Obstet Gynecol Soc. 1955; 2:178–203. PMID: 13286539.

2. Ilancheran A, Monaghan JM. Pelvic lymphocyst--a 10-year experience. Gynecol Oncol. 1988; 29:333–336. PMID: 3345953.

3. Conte M, Panici PB, Guariglia L, Scambia G, Greggi S, Mancuso S. Pelvic lymphocele following radical para-aortic and pelvic lymphadenectomy for cervical carcinoma: incidence rate and percutaneous management. Obstet Gynecol. 1990; 76:268–271. PMID: 2196500.

4. Logmans A, Kruyt RH, de Bruin HG, Cox PH, Pillay M, Trimbos JB. Lymphedema and lymphocysts following lymphadenectomy may be prevented by omentoplasty: A pilot study. Gynecol Oncol. 1999; 75:323–327. PMID: 10600283.

5. Benedetti-Panici P, Maneschi F, Cutillo G. Pelvic and aortic lymphadenectomy. Surg Clin North Am. 2001; 81:841–858. PMID: 11551129.

6. Shingleton HM, Orr HW. Cancer of the cervix: Diagnosis and Treatment in Current reviews in obstetrics and gynecology. 1993. Vol. 5. Edinburgh: Churchill Livingstone.

7. Symmonds RE, Pratt JH. Prevention of fistulas and lymphocysts in radical hysterectomy. Preliminary report of a new technic. Obstet Gynecol. 1961; 17:57–64. PMID: 13774382.

8. Catalona WJ, Kadmon D, Crane DB. Effect of mini-dose heparin on lymphocele formation following extraperitoneal pelvic lymphadenectomy. J Urol. 1980; 123:890–892. PMID: 7382008.

9. Rutledge F, Dodd GD Jr, Kasilag FB Jr. Lymphocysts; a complication of radical pelvic surgery. Am J Obstet Gynecol. 1959; 77:1165–1175. PMID: 13649788.

10. Pennehouat G, Mosseri V, Durand JC, Hamelin JP, Asselain B, Pilleron JP, et al. Lymphoceles and peritonization following lymphadenectomy for cancer of the uterus. J Gynecol Obstet Biol Reprod (Paris). 1988; 17:373–378. PMID: 3294282.

11. Clarke-Pearson DL, Jelovsek FR, Creasman WT. Thromboembolism complicating surgery for cervical and uterine malignancy: incidence, risk factors, and prophylaxis. Obstet Gynecol. 1983; 61:87–94. PMID: 6823353.

12. Orr JW Jr, Barter JF, Kilgore LC, Soong SJ, Shingleton HM, Hatch KD. Closed suction pelvic drainage after radical pelvic surgical procedures. Am J Obstet Gynecol. 1986; 155:867–871. PMID: 3766643.

13. White M, Mueller PR, Ferrucci JT Jr, Butch RJ, Simeone JF, Neff CC, et al. Percutaneous drainage of postoperative abdominal and pelvic lymphoceles. AJR Am J Roentgenol. 1985; 145:1065–1069. PMID: 3901705.

14. Benedetti-Panici P, Maneschi F, Scambia G, Mancuso S. A new transabdominal approach to the left retroperitoneum for systematic removal of lymph nodes left of the aorta in gynecologic malignancies. Obstet Gynecol. 1994; 83:1060–1064. PMID: 8190424.

15. Metcalf KS, Peel KR. Lymphocele. Ann R Coll Surg Engl. 1993; 75:387–392. PMID: 8285540.

16. Blebea J, Choudry R. Thigh isosulfan blue injection in the treatment of postoperative lymphatic complications. J Vasc Surg. 1999; 30:350–354. PMID: 10436456.

17. Petru E, Tamussino K, Lahousen M, Winter R, Pickel H, Haas J. Pelvic and paraaortic lymphocysts after radical surgery because of cervical and ovarian cancer. Am J Obstet Gynecol. 1989; 161:937–941. PMID: 2801842.

18. Livingston WD, Confer DJ, Smith RB. Large lymphoceles resulting from retroperitoneal lymphadenectomy. J Urol. 1980; 124:543–546. PMID: 7420600.

19. Spiegel RA, Hessel SJ, Katz ER, Levy JM. Pelvic fullness, urgency and frequency following lymphadenectomy. Pelvic lymphocele. West J Med. 1987; 147:357–358. PMID: 3673073.

20. Terada KY, Roberts JA. Lymphoceles following second-look laparotomy for ovarian cancer. Gynecol Oncol. 1988; 29:382–384. PMID: 3345957.

21. Benedet JL, Turko M, Boyes DA, Nickerson KG, Bienkowska BT. Radical hysterectomy in the treatment of cervical cancer. Am J Obstet Gynecol. 1980; 137:254–262. PMID: 7377245.

22. Nelson JH Jr, HUston JW. Lymphocyst formation following pelvic lymphadenectomy. Am J Obstet Gynecol. 1959; 78:1298–1300. PMID: 14426460.

23. de Roo T. The value of lymphography in lymphedema. Surg Gynecol Obstet. 1967; 124:755–765. PMID: 6019288.

24. Ferguson JH, Maclure JG. Lymphocele following lymphadenectomy. Am J Obstet Gynecol. 1961; 82:783–792. PMID: 13892338.

25. Fung YM, Wong WS. Malignant lymphocyst after Wertheim's operation. Gynecol Oncol. 1992; 44:288–290. PMID: 1541444.