Complications of pelvic lymphadenectomy in 1,380 patients undergoing radical retropubic prostatectomy between 1993 and 2006

Purpose: We evaluated the perioperative complications associated with pelvic lymphadenectomy in patients undergoing radical retropubic prostatectomy. In particular the influence of the extent of pelvic lymphadenectomy and of other possible risk factors on the complication rate was examined. Materials and Methods: All intraoperative and early postoperative complications in 1,380 patients who underwent radical retropubic prostatectomy were documented. Complications related to pelvic lymphadenectomy were described and evaluated statistically to explore the role of possible risk factors. Results: Limited pelvic lymphadenectomy was performed in 867 patients and an extended procedure was done in 434. In 60 cases pelvic lymphadenectomy was not specified and in 19 pelvic lymphadenectomy was omitted. Intraoperative complications associated with pelvic lymphadenectomy were rare events (8 cases). Early postoperative complications included hemorrhage of the obturator artery in 1 patient, symptomatic lymphocele in 72, thromboembolic sequelae in 6 and lymphocele infection in 2. Lymphocele formation depended on the extent of pelvic lymphadenectomy (p < 0.0001), the number of lymph nodes removed (p = 0.0038) and the operating surgeon (p = 0.0073). Thromboembolic events (p = 0.001) and re-interventions (p < 0.0001) were more frequent in patients with a lymphocele. Multivariate analysis confirmed extended pelvic lymphadenectomy as an independent risk factor for lymphocele and re-intervention. Conclusions: Pelvic lymphadenectomy is the cause of a relevant number of perioperative complications in patients undergoing radical retropubic prostatectomy. Lymphocele formation, and the associated re-interventions and thromboembolic sequelae account for by far the highest percent of these complications. In the current study lymphocele formation depended on the extent of pelvic lymphadenectomy, the number of lymph nodes removed and the operating surgeon.