RESUMEN
A meta-analysis investigation was executed to measure the wound infection (WI) in robotic-assisted radical prostatectomy (RRP) compared with retropubic radical prostate surgery (RRPS). A comprehensive literature investigation till February 2023 was applied, and 1197 interrelated investigations were reviewed. The 19 chosen investigations enclosed 107 153 individuals with prostate cancer (PC) at the starting point. 72 008 of them were utilising RRP, and 35 145 were utilising RRPS. Odds ratio (OR) in addition to 95% confidence intervals (CIs) was utilised to compute the value of the WI in RRP compared with RRPS by the dichotomous approaches and a fixed or random model. RRP had significantly lower surgical site wound infection (SSWI) (OR, 0.33; 95% CI, 0.21-0.52, P < .001) and infected lymphoceles (ILs) (OR, 0.45; 95% CI, 0.22-0.92, P = .03) compared with RRPS in individuals with PC. RRP had significantly lower SSWI and ILs compared with RRPS in individuals with PC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.
Asunto(s)
Laparoscopía , Neoplasias de la Próstata , Procedimientos Quirúrgicos Robotizados , Masculino , Humanos , Próstata , Procedimientos Quirúrgicos Robotizados/efectos adversos , Prostatectomía/efectos adversos , Neoplasias de la Próstata/cirugía , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/cirugíaRESUMEN
OBJECTIVE: To evaluate risk factors, microbiology and management of infected lymphocysts in patients undergoing systemic lymphadenectomy for gynecological cancer. METHODS: Patients with gynecological cancer who developed postoperative lymphocysts after lymphadenectomy were enrolled between January 2009 and June 2017. The clinical data of infected lymphocysts were analyzed and compared with non-infected lymphocysts. Multivariate analysis of risk factors, the microbiology and therapeutic strategies for infected lymphocysts were also evaluated. RESULTS: A total of 115 patients out of 619 developed postoperative lymphocysts, the incidence of infected lymphocysts was 4.36%. Infected lymphocysts were more frequently found in patients with combined pelvic and para aortic lymphadenectomy, higher number of resected pelvic lymph nodes, lower level of postoperative serum hemoglobin and higher proportion of neutropenia. The median diameter of infected lymphocysts was significantly larger than non-infected (71.89 vs 38.47 mm, P < 0.001) and a large size (diameter over 60 mm) was identified as an independent risk factor for infected lymphocysts (OR = 3.933, P = 0.017). The microbiology of infected lymphocysts includes gram-positive cocci, gram-negative bacillus and anaerobic bacteria. Percutaneous catheter drainage was successfully performed in 20 patients with infected lymphocysts. 16 of 19 patients with large lymphoceles received combined antibiobics and PCD therapy and showed clinical remission in all cases. Patients with large size infected lymphocysts who received combined therapy experienced a significantly shorter treatment period and lower recurrent rate than those with only antibiotics (P = 0.046, P = 0.018). CONCLUSIONS: The current study demonstrated that a diameter over 60 mm was an independent risk factor for infected lymphocysts. The predominant bacteria originated from the urogenital or skin flora. The combination of PCD with appropriate antibiotics was a convenient and effective therapeutic strategy resulting in a high success rate.