Several confounding factors complicate any evaluation of the morbidity of pelvic lymphadenectomy. First, the extent of the lymphatic dissection has differed between surgeons and over time as the technique has evolved. Second, pelvic lymphadenectomy can be performed in a number of ways: (1) through a traditional lower midline incision; (2) a mini-lap incision; or (3) laparoscopically. These factors influence the overall complication rate, for example, the incidence of intraoperative neural and vascular injury, the rate of lymphocele formation and the extent of postoperative lymphedema. Ordinarily, pelvic lymphadenectomy is performed immediately before definitive treatment for prostate cancer, such as radical prostatectomy, or radioactive seed placement under the same anesthetic or external beam radiation within the perioperative period. For this reason, it can be difficult to differentiate complications attributable to the pelvic lymphadenectomy procedure from those related to the therapy and/or the adjuvant therapy. In Table 27.1 we review the complication rates for 26 published pelvic lymphadenectomy series. The data are separated both by technique and whether or not lymphadenectomy was accompanied by a therapeutic intervention. Keeping this in mind, we review complication rates for 25 published series of pelvic lymphadenectomy in Table 27.1.9,11,49-70 Note that only five of these series include solely patients undergoing open pelvic lymphadenectomy as an independent procedure.49'56'62'63'67
Several complications can be directly linked to the lymphadenectomy procedure itself. Injury of the obturator nerve, obturator blood vessels, iliac vein and/or artery, can all occur during pelvic lymphadenectomy and would not be anticipated during any of the therapeutic interventions that are commonly associated with prostate cancer interventions. Delayed
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