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Clinical Importance of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review and Meta-Analysis.
Deutsch, Sebastian; Hadaschik, Boris; Lebentrau, Steffen; Ubrig, Burkhard; Burger, Max; May, Matthias.
Afiliação
  • Deutsch S; Department of Urology, University Hospital Essen, Essen, Germany, deutsch.bastian@web.de.
  • Hadaschik B; Department of Urology, University Hospital Essen, Essen, Germany.
  • Lebentrau S; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.
  • Ubrig B; Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany.
  • Burger M; Department of Urology, Augusta Kliniken Bochum Hattingen, Bochum, Germany.
  • May M; Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.
Urol Int ; 106(1): 28-34, 2022.
Article em En | MEDLINE | ID: mdl-33567440
ABSTRACT

BACKGROUND:

Robot-assisted radical prostatectomy (RARP) including pelvic lymph node dissection (PLND) is the current state of the art in surgical therapy of localized prostate cancer with intermediate or high risk. PLND in particular is associated with morbidity inherent to this method; the rate of symptomatic lymphoceles (sLCs), for example, ranges up to 10%.

OBJECTIVE:

Various intraoperative modifications have been developed with the aim of reducing the sLC rate. Based on current studies, a peritoneal interposition flap (PIF) appears to be one of the most effective methods for this purpose. Under the criteria of a systematic review, 5 retrospective studies have been identified until now, 4 of which showed a positive effect of PIF on the sLC rate. RESULTS AND

LIMITATIONS:

A total of 1,308 patients were included in the aggregated analysis of these 5 studies. The amount of sLCs was 1.3% (8/604) and 5.7% (40/704) in the PIF and standard groups, respectively (p < 0.001). The resulting odds ratio (OR) was 0.23 (95% confidence interval [CI] 0.05-0.99), taking in-to account a noteworthy heterogeneity of the 5 studies (Q = 9.47, p = 0.05; I2 = 58%). In addition, a prospective randomized and blinded study (Pianoforte trial) with corresponding sLC rates of 8.3% (9/108) versus 9.7% (12/124) (p = 0.820) exists. In this study, the OR was 0.85 (95% CI 0.34-2.10, p = 0.722).

CONCLUSION:

Despite positive results from retrospective studies with indirect evidence, the role of the PIF in the reduction of sLC in RARP could not be conclusively assessed yet. The results of the first prospective randomized study do not show a positive effect of PIF, declaring a research gap for further studies with direct evidence.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Peritônio / Complicações Pós-Operatórias / Prostatectomia / Retalhos Cirúrgicos / Linfocele / Procedimentos Cirúrgicos Robóticos / Excisão de Linfonodo Tipo de estudo: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Peritônio / Complicações Pós-Operatórias / Prostatectomia / Retalhos Cirúrgicos / Linfocele / Procedimentos Cirúrgicos Robóticos / Excisão de Linfonodo Tipo de estudo: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article