The incidence of lymphocyst following gynecologic cancer surgery andthe factors associated with lymphocyst formation

ABSTRACT Karatas, E., The Incidence of Lymphocyst Following Gynecologic Cancer Surgery and The Factors Associated with Lymphocyst Formation, Hacettepe University Faculty of Medicine, Thesis in Obstetrics and Gynecology, Ankara 2021. Objective: The objective of this study was to investigate the incidence of lymphocyst development in the post-operative period and the clinical, surgical and pathological factors affecting it in patients who underwent surgical treatment with the diagnosis of gynecological cancer and underwent pelvic and/or paraaortic lymphadenectomy during surgery. Materials-Methods: Patients who were operated on with the preliminary diagnosis of endometrium, ovarian and cervical cancer in Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology between January 2014 and August 2019, as a primary treatment approach or after neoadjuvant treatments, and who underwent pelvic and/or cervical cancer during this operation. 614 patients who underwent paraaortic lymphadenectomy or paraaortic lymphadenectomy were included in the study retrospectively. Results: Of 614 patients included in the study, 45% were operated for endometrial cancer, 42.6% for ovarian cancer, and 12.4% for cervical cancer. A total of 187 (30.5%) patients were found to develop lymphocysts in the postoperative period. It was observed that lymphocysts developed most frequently in the pelvic region (91.4%). Lymphocyst development was not affected by primary type of cancer. Although more lymphocysts were detected in patients with ovarian cancer, this was not statistically significant. Similarly, age, menopausal status, complete staging surgery or lymphadenectomy only, use of pelvic drains or absorbable hemostats were also found to be factors that did not affect the risk of lymphocyst formation. Despite these, paraaortic lymphadenectomy, neoadjuvant therapy and adjuvant therapy were found to be significantly associated with lymphocyst formation. Symptoms or complications requiring intervention occurred in only 16 (8.6%) of the patients who developed lymphocyst and in only 2.6% of the study group. The most common reason for intervention in these patients was infection within the lymphocyst. Conclusion: Lymphocyst formation is a very common complication after gynecological cancer surgeries. Most lymphocysts are asymptomatic and are often detected incidentally during routine post-operative follow-up. Considering the severity of the underlying malignancy, lymphocysts appear to be of little clinical importance, but they can cause additional morbidity and can sometimes be complicated and require additional intervention which may delay the initiation of adjuvant therapies. Key Words: Gynecologic Cancer, Ovarian cancer, Endometrial cancer, Cervical cancer, Lymphadenectomy, Lymphocyst.