Peritoneal interposition flap reduces symptomatic lymphocele following transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection: An updated meta-analysis

Abstract

Background: Robot-assisted radical prostatectomy with intraoperative pelvic lymph node dissection is the criterion standard for surgical treatment of nonmetastatic intermediate- and high-risk prostate cancer. However, this method is associated with symptomatic lymphocele (SLC), which is an important morbidity factor. To overcome this complication, several modifications of the technique have been developed, including the peritoneal interposition flap (PIF). We performed an updated systematic review and meta-analysis to investigate the efficacy and safety of this technique for preventing SLC and lymphocele (LC) formation.

Materials and methods: Searches were performed using databases and references from included studies and previous systematic reviews. Only randomized controlled trials and nonrandomized cohorts were included. Primary outcomes were the incidence of SLC and LC formation, and safety outcomes were defined as operation time, estimated blood loss, length of hospital stay, and urinary incontinence. Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool. Pooled treatment effects were estimated using odds ratios with 95% confidence intervals (CIs) for binary endpoints. Heterogeneity was examined using Cochran's Q test and I² statistics; p values < 0.10 and I² > 25% were considered significant for heterogeneity. We used Mantel-Haenszel fixed-effect models in the analyses with low heterogeneity. Otherwise, the DerSimonian and Laird random-effects model was used.

Results: The initial search yielded 510 results. After the removal of duplicate records and application of the exclusion criterion, 9 studies were fully reviewed for eligibility. Three randomized controlled trials and 5 retrospective cohorts met all the inclusion criteria, comprising 2261 patients, of whom 1073 (47.4%) underwent PIF. Six studies reported a significant reduction in SLC in the PIF group, and 3 of the 4 studies reported LC formation yielded significant results in preventing this complication. The incidence of SLC and LC formation in a follow-up of ≥3 months was significantly different between the PIF and no PIF group (odds ratio, 0.34 [95% CI, 0.16-0.74; p = 0.006] and 0.48 [95% CI, 0.31-0.74; p = 0.0008]), respectively. The safety outcomes did not differ significantly between the 2 groups.

Conclusions: These results suggest that PIF is an effective and safe technique for preventing LC and SLC in patients undergoing transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection.

Keywords

Robot-assisted radical prostatectomy / Lymphocele / Peritoneal reapproximation / Peritoneal interpolated flap / Meta-analysis

Acknowledgments

None

Statement of ethics

The present systematic review and meta-analysis was performed in accordance with the recommendations of the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement guidelines.

Conflict of interest statement

No conflict of interest has been declared by the authors.

Funding source

None.

Author contributions

JHSP: Research design, writing of the paper, performance of the research, data collection, analysis, and interpretation;

LVSR: Writing of the paper, performance of the research and data collection;

JPM: Writing of the paper, analysis and interpretation;

All authors: Critical revision of the article and final approval.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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