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Comparison of peritoneal interposition flaps and sealants for prevention of lymphocele after robotic radical prostatectomy and pelvic lymph node dissection: a systematic review, meta-analysis, Bayesian network meta-analysis, and meta-regression

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Abstract

Lymphocele is one of the most common complications after radical prostatectomy. Multiple authors have proposed the use of vessel sealants or peritoneal interposition techniques as preventive interventions. This study aimed to aggregate and analyze the available literature on different interventions which seek to prevent lymphocele through a Bayesian Network. A systematic review was performed to identify prospective studies evaluating strategies for lymphocele prevention after robot assisted laparoscopic prostatectomy + pelvic lymph node dissection. Data was inputted into Review Manager 5.4 for pairwise meta-analysis. Data was then used to build a network in R Studio. These networks were used to model 200,000 Markov Chains via MonteCarlo sampling. The results are expressed as odds ratios (OR) with 95% credible intervals (CrI). Meta-regression was used to determine coefficient of change and adjust for pelvic lymph node dissection extent. Ten studies providing data from 2211 patients were included. 1097 patients received an intervention and 1114 patients served as controls. Interposition with fenestration had the lowest risk of developing a lymphocele (OR 0.14 [0.04, 0.50], p = 0.003). All interventions, except sealants or patches, had significant decreased odds of lymphocele rates. Meta-analysis of all the included studies showed a decreased risk of developing a lymphocele (OR 0.42 [0.33, 0.53], p < 0.00001) for the intervention group. Perivesical fixation and interposition with fenestration appear to be effective interventions for reducing the overall incidence of lymphocele.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA

    David E. Hinojosa-González, Gal Saffati, Shane Kronstedt, Troy La, Jeffrey A. Jones, Dov Kadmon, Justin Badal, Jennifer M. Taylor & Jeremy R. Slawin

  2. UMass Chan Medical School, Worcester, MA, USA

    Cedrick Chiu

  3. University of Kentucky College of Medicine, Lexington, KY, USA

    Eric Wahlstedt

  4. Michael E. DeBakey VA Medical Center, Houston, TX, USA

    Jeffrey A. Jones, Dov Kadmon, Justin Badal, Jennifer M. Taylor & Jeremy R. Slawin

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  1. David E. Hinojosa-González
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Contributions

Conception and Design: David E. Hinojosa-González, Gal Saffati, Shane Kronstedt. Acquisition of Data: David E. Hinojosa-González, Gal Saffati, Troy La. Analysis and Interpretation of data: David E. Hinojosa-González, Gal Saffati, Shane Kronstedt, Troy La, Cedrick Chiu, Eric Wahlstedt. Drafting the manuscript: David E. Hinojosa-González, Gal Saffati, Shane Kronstedt, Cedrick Chiu, Eric Wahlstedt. Critical revision of the manuscript for important intellectual content: Jeffrey A. Jones, Dov Kadmon, Justin Badal, Jennifer M. Taylor, Jeremy R. Slawin. Statistical Analysis: David E. Hinojosa-Gonzalez. Funding NA. Administrative technical support: NA. Supervision: Jeffrey A. Jones, Dov Kadmon, Justin Badal, Jennifer M. Taylor, Jeremy R. Slawin.

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Correspondence to David E. Hinojosa-González.

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Hinojosa-González, D.E., Saffati, G., Kronstedt, S. et al. Comparison of peritoneal interposition flaps and sealants for prevention of lymphocele after robotic radical prostatectomy and pelvic lymph node dissection: a systematic review, meta-analysis, Bayesian network meta-analysis, and meta-regression. J Robotic Surg 18, 177 (2024). https://doi.org/10.1007/s11701-024-01918-6

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