Presentation Authors: Yannic Raskin*, Cedric Jorissen, Steven Joniau, Wouter Everaerts, Leuven, Belgium
Introduction: The therapeutic benefit of an extended pelvic lymph node dissection (ePLND) in the surgical treatment of localized prostate cancer is still open for debate. On the other hand, an ePLND is associated with significant additional peri- and postoperative complications, the most frequent one being secondary lymphedema. In this single center prospective analysis, we aim to determine the prevalence, possible risk factors and the effect on quality of life.
Methods: We have prospectively registered 139 patients who received a robot-assisted radical prostatectomy with ePLND from 2015 to 2018 at our center. Exclusion criteria were conversion to open procedure, salvage cases and follow-up < 5mo. The presence of lymphedema was evaluated in a standardized manner. Quality of life was assessed for by the EORTC QLQ-C30. Four possible risk factors were analyzed: BMI, age, adjuvant radiotherapy and presence of a symptomatic lymphocele.
Results: After applying inclusion and exclusion criteria, the study population counted 139 patients. In 29/139 (20.8%) patients, lymphedema was present during the last consultation. Significant swelling existed in 16/29 (55.1%) patients in the upper left leg, in 15/29 (51.7%) in the upper right leg, in 14/29 (48.2%) in the lower left leg and in 17/29 (58.6%) in the lower right leg. Bilateral lymphedema occurred in 15/29 (51.7%) patients. Two patients (6.9%) presented with scrotal edema. Mean age was 64,7yo (SD Â± 6.22) in the lymphedema group vs. 64,5yo (SD Â± 6.75, p=0.974) in the non-lymphedema group. Mean pre-operative BMI was 27.4 kg/m2 (SD Â± 3.61) vs. 26.25 kg/m2 (SD Â± 2.96, p=0.161). Adjuvant radiotherapy was administered in 9/29 (31%) vs. 11/110 (10%, p=0.004). A symptomatic lymphocele formation had been present in 5/29 (17.2%) vs. 9/110 (8.2%, p=0.149). EORTC QLQ-C30 subgroups rated: global health status (80.39 vs 73.69), physical functioning (93.83 vs 85.88), role functioning (95.22 vs 77.54), emotional functioning (85.6 vs 76.62) and social functioning (92.67 vs 80.08).
Conclusions: The prevalence of lymphedema after ePLND during radical prostatectomy (20.8 %) is much higher than previously reported. Lymphedema is associated with important effects on the physical and emotional well-being of patients. We confirm adjuvant radiotherapy as a risk factor for the development of lymphedema, whereas age, BMI and symptomatic lymphoceles were not withheld.