Purpose: Lymphocele (LC) is the most common adverse sequela of pelvic lymphadenectomy (PLND) during radical prostatectomy for prostate cancer. Current evidence on comparison between robotic (RARP) and open retropubic prostatectomy (RRP) in terms of the development of symptomatic LCs (SLCs) is conflicting. Moreover, no single-center assessment has illuminated the impact of the anterior vs. posterior approach of RARP on the rate of SLCs yet. We aimed to compare RRP and transperitoneal RARP for the SLC development and associated clinical risk factors.
Methods: Patients treated with RRP or transperitoneal RARP (both with standard PLND) were included. Univariate comparisons and multivariate logistic regression analysis were utilized to compare the cohorts and define independent predictive variables for the development of SLCs.
Results: Five hundred and ninety-five consecutive PCa patients underwent RRP and 277 ones RARP (76 anterior and 201 posterior approaches). The incidence of SLCs did not differ between both cohorts. Age and lymph node yield were independent predictors for the development of SLCs after RRP. There was a trend for a longer median time to development of SLCs after RARP as compared to RRP. Median duration of percutaneous drainage tended to be higher after RRP then after RARP. Failure rate of lymphocele drainage was comparable between both techniques.
Conclusions: RRP and RARP are associated with the same risk for the development of a SLC. Posterior approach does not reduce the SLC formation compared to the anterior technique. Patients' age and LN yield are predictive for the SLC occurrence in patients treated with RRP.
Keywords: Lymph node excision; Lymphocele; Prostate cancer; Prostatectomy; Risk factors.