Introduction/Background Pelvic and para-aortic lymphadenectomy has been considered a standard procedure in encountering and treating patients with various gynecological malignancies. On the other hand, formation of lymphoceles are considered the most common early or late lymphadenectomy-related complications. The present study aimed to evaluate the safety and efficacy of application of fibrin-collagen sealants on lymphadenectomy areas in the formation of lymphocele after lymphadenectomy in patients with gynecological malignancies.
Methodology A systematic search of 6 electronic databases for articles published up to April 2019, along with the reference lists of articles which were retrieved in full text, was performed. All randomised controlled clinical trials (RCTs) which evaluated the effect of fibrin sealant patches in the prevention of lymphocele, were considered eligible for inclusion in the present meta-analysis. Statistical meta-analysis was performed using the RevMan 5.3 software.
Results Six RCTs with a total of 481 patients were finally recruited. Among them, 178 patients were treated with fibrin sealant while the remaining 192 women underwent lymphadenectomy without application of fibrin sealant. A significant decline was observed either in the total amount of fluid which was postoperatively drained or in mean duration of drainage in fibrin sealant group, compared to control, (187 women MD -86.40 ml 95% CI -100.2 to -72.60 p < 0.00001 and 113 patients MD -1.00 days 95% CI -1.13 to -0,87 p < 0.00001, respectively). On the other hand, the incidence of lymphoceles, overall and symptomatic ones, did not differ among the two groups (p = 0.08, and p = 0.22, respectively).
Conclusion According to the findings of the present meta-analysis, the application of fibrin sealants in pelvic and/or para-aortic areas after lymphadenectomy due to gynecologic cancer is safe and efficient. However, its benefit still remains elusive. In that setting, despite associated with significant decrease in the duration and volume of drainage, it was not proved efficient in minimising the incidence of lymphocele.
Disclosure Nothing to disclose
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