Prevention of Lymphoceles Using FloSeal and CoSeal After Laparoscopic Lymphadenectomy in Patients With Gynecologic Malignancies

Introduction: Pelvic +/- para-aortic lymphadenectomy (LAB) is an essential element of staging and treatment of different gynecologic malignancies. However, LAB can induce asymptomatic and symptomatic pelvic lymphoceles (LCs) in a considerable percentage of patients. Therapy of symptomatic LCs may cause additional morbidity. The best strategy to reduce the rate of LCs has not established yet. Materials and Methods: Between January 2011 and May 2012, transperitoneal laparoscopic pelvic +/- para-aortic LAB was performed at the Department of Gynecology at Charite University Hospital Berlin in 238 patients with cervical, endometrial, ovarian, or groin-positive vulvar cancer. The application of FloSeal (Baxter, Deerfield, IL) and CoSeal (Baxter) was used in 25 patients (group A) as an alternative to routine pelvic drainage after LAB. A case-control comparison was performed on 25 patients (group B) with bilateral drainage after complete LAB. The primary objective of this pilot study was to evaluate the feasibility and safety of the method. As a secondary objective, we evaluated the incidence of LCs and symptomatic LCs in both groups. The detection of LCs was performed during oncologic follow-up by sonography, computed tomographic imaging, or magnetic resonance imaging. Measurements and Main Results: Pelvic (n = 50) or pelvic + para-aortic (n = 42) LAB was performed in 44 patients with cervical, 2 with endometrial 1 with ovarian, and 2 with groin-positive vulvar cancer, respectively. In group B (n = 25), systematic bilateral pelvic drainage was placed after finishing LAB, whereas in group A (n = 25) LAB areas were sealed with 5 mL FloSeal on each side and sprayed with CoSeal afterward without placing drains. In 14 of 50 patients (28%), LCs were detected. In a subgroup of patients with cervical cancer (88% of the cohort), symptomatic LCs occurred in 11% in group A and 18% in group B. Operative revision of symptomatic LCs was necessary in 5% and 18% in groups A and B, respectively (p = .66). Mean Hospital stay was significant shorter in group A (6 days) versus B (8 days) (p = .027). Conclusion: The results of this case-controlled pilot study indicate that the application of FloSeal and CoSeal after transperitoneal LAB is feasible and safe, may reduce hospital stay, and may potentially decrease the rate of symptomatic LCs in patients with gynecologic malignancies. (C) 2015 AAGL. All rights reserved.