Large or persistent lymphocyst increases the risk of lymphedema, lymphangitis, and deep vein thrombosis after retroperitoneal lymphadenectomy for gynecologic malignancy

Purpose This retrospective study examined the incidence of lymphocyst formation after retroperitoneal lymphadenectomy in patients with gynecologic malignancy as well as the relation between lymphocyst formation and such complications as lymphedema, lymphangitis, ileus, and deep vein thrombosis (DVT). Methods Three hundred twenty-one patients who underwent primary surgery with pelvic (90 patients) or combined pelvic and paraaortic lymphadenectomy (231 patients) for gynecologic malignancy between January 2001 and December 2009 were enrolled. The incidences of lymphocyst identified by computed tomography at 3 weeks and 1 year after surgery were analyzed in relation to the types of surgery and types of complications. Results At 3 weeks after surgery, lymphocysts were observed in 282/321 patients (88 %). At 1 year after surgery, lymphocysts persisted in 69 patients (21 %). Lymphedema was observed in 34/321 (11 %) patients, lymphangitis in 36/321 (11 %), ileus in 14/321 (4 %), and DVT in 24/321 (7 %). The incidence of lymphedema was significantly greater in patients with persistent lymphocyst than in those with without (17 vs. 9 %) ( p = 0.038); the incidences of lymphangitis (20 vs. 9 %) ( p = 0.007) were also greater in this group. Multivariate analysis showed a large lymphocyst (>50 mm) at 3 weeks after surgery to be an independent risk factor for lymphedema (odds ratio 2.76, p = 0.009). Conclusions A large lymphocyst at 3 weeks after surgery or persistent lymphocyst increases the risk of lymphedema, lymphangitis, and DVT.