Retroperitoneal drainage after complete para-aortic lymphadenectomy for gynecologic cancer: A randomized trial

Objective: To determine the relationship between retroperitoneal drainage after complete para-aortic lymphadenectomy for gynecologic cancer and subsequent development of lymphocysts. Methods: Eighty women undergoing complete para-aortic lymphadenectomy up to the level of the left renal vein for ovarian (n = 43) or cervical carcinoma (n = 37) were randomly assigned to receive drainage or no drainage of the para-aortic area. Most of patients had pelvic drainage. Abdominopelvic ultrasonography was done 8 to 12 days after surgery. Postoperative complications, duration of hospital stay, and characteristics of asymptomatic lymphocysts were studied. Results: Forty-two women had para-aortic drainage and 38 did not. Complications occurred in 15 patients who had drainage and in 5 patients who did not have drainage (36% versus 13%; P < .02). Three patients (8%) in the undrained group had complications potentially related to drainage (symptomatic lymphocysts or ascites) compared with 11 (26%) in the drained group (χ² = 4.6; P < .05). Median duration of the hospital stay was 9 days in the undrained group and 11 days in the drained group (P < .03). The number of asymptomatic para-aortic lymphocysts detected during the ultrasonography was 9 (24%) in the undrained and 2 (5%) in the drained group (χ² = 4.6; P < .05). Conclusions: The number of asymptomatic para-aortic lymphocysts was higher in patients who did not undergo drainage, but morbidity and the duration of hospitalization were increased in these patients. Routine drainage of the retroperitoneum after para-aortic lymphadenectomy should be abandoned.