Analysis Of Influencing Factors Of Pelvic Lymphocyst Formation After Robot-assisted Laparoscopic Gynecological Malignant Tumor Surgery

Background and ObjectivtLymphatic complications after treatment for gynecologic cancer substantially impact the patients’ quality of life.Lymphocyst with an incidence of 27%is the most common lymphatic complication after gynecologic cancer treatment.Especially for severe postoperative pelvic lymphatic cyst,once it occurs,the patient needs long-term care,attention and psychological support.Robot-assisted laparoscopic surgery is one of the latest innovations in the field of minimally invasive surgery,which has been carried out in urology,cardiac surgery and general surgery for many years.Robot-assisted laparoscopic surgery provides three-dimensional visualization of the surgical field,reduces surgeon fatigue and tension tremor,increases wrist movement to improve dexterity,and has unique advantages in removing lymph nodes.Nevertheless,patients with gynecological malignancies undergoing robot-assisted laparoscopic pelvic and para-aortic lymphadenectomy will also have a variety of complications,and pelvic lymphocyst is one of the more common complications,and prevention and treatment of postoperative lymphocyst formation is still a big problem.This study collected clinical data of patients who underwent Da Vinci robot-assisted laparoscopic pelvic and abdominal lymphadenectomy due to gynecological malignancies in the First Affiliated Hospital of Zhengzhou University.To explore the risk factors of lymphocyst after pelvic and abdominal lymphadenectomy,in order to guide clinicians to take relevant preventive measures to reduce the incidence of lymphocyst and improve the treatment effect.Research objects and methods1.Retrospective analysis of 186 patients who underwent Finch robot-assisted laparoscopic pelvic lymphadenectomy for gynecological malignancies in the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2019.They were divided into lymphocyst according to whether they formed lymphocyst.Group and no lymphocyst group.This study was approved by the medical ethics committee of our hospital,and all patients and their families gave informed consent.Inclusion criteria:Da Vinci robot-assisted laparoscopic pelvic lymphadenectomy and/or para-aortic lymphadenectomy were performed;all were diagnosed as malignant tumors by routine pathological results after surgery;adjuvant treatments were completed;all treatments were in my The hospital performed pelvic color Doppler ultrasound to evaluate pelvic lymphocysts.Exclusion criteria:persons with other malignant tumors or a history of malignant tumors;history of preoperative radiotherapy and chemotherapy;patients with incomplete clinical data.2.Perform pelvic color Doppler ultrasound before the first postoperative chemotherapy(about 2 weeks after surgery),and routinely perform pelvic ultrasound before each chemotherapy,and recheck color Doppler ultrasound within 6 months after surgery if it suggests lymph Cysts whose size can be measured are judged as pelvic lymphocyst formation.The age,clinical disease stage,intraoperative blood loss,range and number of lymph nodes removed,postoperative abdominal drainage time,and whether there is concurrent radiotherapy and chemotherapy after surgery were collected for patients with and without pelvic lymphatic cysts.,Operation time,BMI index and other data.3.Using SPSS25.0 statistical software,single factor analysis using 2 test,multivariate analysis using logistic regression model analysis,P value<0.05 considered the difference to be statistically significant.Results1.The application of 2 tests the univariate analysis of whether lymphatic cysts will be formed after surgery and the clinical characteristics of the patients,suggesting whether postoperative pelvic lymphatic cysts are complicated with intraoperative blood loss(P=0.137),abdominal drainage time(P=0.680),There was no significant correlation between the length of operation(P=0.347),tumor type(P=0.271),and whether postoperative hypoproteinemia(P=0.159)occurred,and the difference was not statistically significant(P>0.05);while patients Age(P=0.035),FIGO staging(P=0.008),range of lymph nodes removed(P=0.010),number(P=0.001),presence or absence of concurrent radiotherapy and chemotherapy(P=0.005),BMI index(P=0.049),it has an impact on whether there is lymphocyst after operation,the difference is statistically significant(P<0.05).2.The dependent variable is the occurrence of pelvic lymphocyst,Logistic regression analysis was performed with age,range and number of lymph nodes removed,FIGO staging,BMI index,and whether postoperative concurrent radiotherapy and chemotherapy were used as independent variables.The results showed that the patient’s age(P=0.535)There was no significant difference in the effect on the formation of pelvic lymphocyst(P>0.05),the range of lymph node resection(P=0.018,OR=2.800),number(P=0.002,OR=3.778),FIGO staging(P=0.008,OR=3.307),BMI index(P=0.027,OR=2.580),whether postoperative concurrent radiotherapy and chemotherapy(P=0.042,OR=2.421),and OR values are all>1,which are independent risk factors for lymphocyst(P<0.05).3.Among forty patients with lymphatic cysts,twenty four(60.0%)patients had left pelvic lymph cysts,fifteen(37.5%)patients had right pelvic lymphcysts,and only one(2.5%)patient had para-aortic lymphocyst.Conclusion1.The scope and number of lymph node resection,FIGO staging,BMI index,postoperative concurrent radiotherapy and chemotherapy are independent risk factors for lymphocyst.The more lymph nodes removed,the wider the scope,the later the FIGO staging,the increase in BMI index,and the postoperative concurrent radiotherapy and chemotherapy will increase the risk of lymphocyst.2.Lymphocysts occur more on the left side of the pelvis than on the right side,and more in the pelvic area than in the para-aortic area.It is speculated that this left-right asymmetry may be related to the difference in pelvic lymphatic drainage rules and the anatomical characteristics of the pelvic cavity.3.In the surgical treatment of cervical cancer,rational use of the advantages of the robotic surgery system in lymph node removal,such as fluorescence imaging technology,wrist-turnable bipolar,etc.,formulate a reasonable range of lymph node removal,give play to the accuracy and flexibility of the robotic system,and strictly control the surgery post-adjuvant radiotherapy and chemotherapy are indicated to prevent the formation of postoperative pelvic lymphocysts,thereby improving the postoperative quality of life of patients with robot-assisted laparoscopic gynecological malignancies.