Symptomatic lymphocele after robot-assisted pelvic lymphadenectomy as part of the primary surgical treatment for cervical and endometrial cancer: a retrospective cohort study

Abstract

Study Objectives: Pelvic lymph node dissection (PLND) is part of the primary treatment for early–stage cervical cancer and high–intermediate risk or high–risk endometrial cancer. Pelvic lymphocele is a postoperative complication of PLND, and when symptomatic, lymphoceles necessitate treatment. The aim of this study was to investigate the incidence and risk factors of symptomatic lymphocele after robot–assisted laparoscopic PLND in cervical and endometrial cancer. Design: Retrospective cohort study. Setting: Single–center academic hospital. Patients: Two hundred and fifty–eight patients with cervical cancer and 129 patients with endometrial cancer. Interventions: Pelvic lymphadenectomy by robot–assisted laparoscopic surgery. Measurements and Main Results: The authors retrospectively included all patients with early–stage cervical cancer and high–intermediate risk or high–risk endometrial cancer who underwent pelvic lymphadenectomy by robot–assisted laparoscopic surgery between 2008 and 2022. Medical records were reviewed for the occurrence of a symptomatic lymphocele. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for developing a symptomatic lymphocele. In total, 387 patients, 258 with cervical cancer and 129 with endometrial cancer, were included in the study. The overall incidence of symptomatic lymphoceles was 9.6% with a median follow–up of 47 months [interquartile range 23–61]. For the entire cohort, smoking was the only significant risk factor for symptomatic lymphoceles identified in univariate (OR 2.47, 95% CI 1.19–5.11) and multivariate analysis (OR 2.42, 95% CI 1.16–5.07). For cervical cancer, body mass index (BMI) (OR 1.09, 95% CI 1.00–1.17) and prior abdominal surgery (OR 2.75, 95% CI 1.22–6.17) were also identified as significant independent risk factors. For endometrial cancer, age was identified as a significant independent risk factor (OR 0.90, 95% CI 0.83–0.97). Conclusion: This single–center cohort study demonstrated an incidence of almost 10% of symptomatic lymphoceles after robot–assisted laparoscopic PLND for cervical cancer and endometrial cancer, with a higher risk observed among patients who smoke at the time of diagnosis. Furthermore, risk factors differ between the 2 populations, necessitating further studies to establish risk models.