Drains versus no drains after pelvic lymphadenectomy to prevent lymphocyst formation in patients with gynaecological cancer

Pelvic lymphadenectomy, the procedure to remove lymph nodes surrounding major blood vessels in the pelvis, is an important component of the surgical management of gynaecological cancers. However, it can lead to complications, especially lymphocyst formation (collection of lymphatic fluid in the pelvis) and its related consequences such as leg swelling, blockage of the ureter, pelvic pain, clot formation in the leg and pelvic vein, bowel motility disorder, and infection. Without clear evidence, placement of suction drains to remove lymphatic fluid that accumulates in the operative area between the peritoneum and the posterior abdominal wall has been traditionally recommended to prevent such complications. The aim of this review is to compare the effects of drains versus no drain in preventing lymphocyst formation following pelvic lymphadenectomy. The review includes four good quality clinical trials in its final analysis. The participants were primarily those who had cancer of the cervix and endometrium, with only one study also including patients with cancer of the ovary. The findings have demonstrated that placement of suction drains is not effective in preventing lymphocysts, especially when the peritoneum (pelvic lining) is left open. In fact, such practice increases the risk of short and long-term lymphocyst formation with related symptoms.