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The formation of lymphocele is a complication occurring after lymphadenectomy, that is, the removal of lymph nodes. Most often due to gynecological or urological malignancy, it may also occur following renal transplantation [1-3]. Extensive vascular or spinal surgery constitutes another, less frequent cause of lymphocele formation [1,4,5]. In 1955, Mori published a series of 68 lymphoceles following radical hysterectomy and lymphadenectomy for cervical cancer [6]. In 1961, Ferguson and Maclure confirmed that lymphoceles are a complication of the lymphatic system, as contrast agent injected into a lymph vessel penetrated into the lymphocele [7].
The majority of lymphoceles is asymptomatic and often represents an incidental finding during postoperative or routine follow-up visits. The incidence of lymphoceles following oncogynecological procedures involving lymphadenectomy is reported as being in the broad range of 1-58% [6,8-11]. Eighty percent of the lymphoceles occur within 2 weeks after surgery, 96% within 6 weeks [12]. Only a minority of lymphoceles (5-34.5%) is symptomatic (Table 1) [11,13-17]. Lymphoceles may be a significant cause of postoperative morbidity and may delay further cancer treatment.
Study (year) |
| Design of study |
| Intervention |
| Patients included (n) |
| Cancer type(s) |
| Imaging technology |
| Pelvic and/or para-aortic lymphadenectomy |
| Surgical approach |
| All lymphoceles (n)/surgeries (n) |
| Symptomatic lymphoceles (n)/surgeries (n) |
| Ref. |
|
Franchi et al. (2007) |
| Randomized |
| Drain vs no drain |
| 234 |
| Cervix, endometrium, vagina |
| US or CT |
| Pelvic |
| Laparotomy |
| 49/234 (20.9%) |
| 8/234 (3.4%) (drain 5.9%; no drain 0.9%) |
| [23] |
|
Yamamoto et al. (2000) |
| Observational |
| Vaginal vault open vs not open |
| 190 |
| Cervix, endometrium, ovary |
| CT |
| Pelvic and para-aortic |
| Laparotomy |
| 20/190 (10.5%) |
| - |
| [22] |
|
Achouri et al. (2013) |
| Retrospective |
| None |
| 88 |
| Cervix, endometrium, ovary |
| US or CT |
| Pelvic and/or para-aortic |
| Laparotomy or laparoscopy |
| - |
| 31/88 (34.5%) |
| [14] |
|
Kim et al. (2004) |
| Retrospective |
| None |
| 264 |
| Cervix, endometrium, ovary |
| US or CT or MRI |
| Pelvic and para-aortic |
| Laparotomy |
| 50/264 (18%) |
| 13/50 (26% of lymphoceles) |
| [13] |
|
Conte et al. (1990) |
| Prospective non-randomized |
| None |
| 36 |
| Cervix |
| US |
| Pelvic and para-aortic |
| Laparotomy |
| 12/36 (33.3%) |
| 5/36 (13.9%) |
| [15] |
|
Petru et al. (1989) |
| Retrospective |
| None |
| 173 cervix, 135 ovary |
| Cervix, ovary |
| US or CT |
| Pelvic and para-aortic |
| Laparotomy |
| 35/173 (20% - cervix); 43/135 (32% - ovary) |
| - |
| [16] |
|
Suzuki et al. (1998) |
| Randomized |
| Closure... |