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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
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Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
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Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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PRISMA flow diagram.
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Figure 3

PRISMA flow diagram.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 1 Short‐term lymphocyst formation: both asymptomatic and symptomatic within 4 weeks after surgery.
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Analysis 1.1

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 1 Short‐term lymphocyst formation: both asymptomatic and symptomatic within 4 weeks after surgery.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 2 Short‐term lymphocyst formation: symptomatic within 4 weeks after surgery.
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Analysis 1.2

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 2 Short‐term lymphocyst formation: symptomatic within 4 weeks after surgery.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 3 Short‐term lymphocyst formation: both asymptomatic and symptomatic at 8 weeks after surgery.
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Analysis 1.3

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 3 Short‐term lymphocyst formation: both asymptomatic and symptomatic at 8 weeks after surgery.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 4 Short‐term lymphocyst formation: both asymptomatic and symptomatic at 12 weeks after surgery.
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Analysis 1.4

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 4 Short‐term lymphocyst formation: both asymptomatic and symptomatic at 12 weeks after surgery.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 5 Long‐term lymphocyst formation: both asymptomatic and symptomatic at 12 months after surgery.
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Analysis 1.5

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 5 Long‐term lymphocyst formation: both asymptomatic and symptomatic at 12 months after surgery.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 6 Long‐term lymphocyst formation: symptomatic at 12 months after surgery.
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Analysis 1.6

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 6 Long‐term lymphocyst formation: symptomatic at 12 months after surgery.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 7 Febrile morbidity.
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Analysis 1.7

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 7 Febrile morbidity.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 8 Pelvic infection.
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Analysis 1.8

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 8 Pelvic infection.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 9 Wound infection.
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Analysis 1.9

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 9 Wound infection.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 10 Wound dehiscence.
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Analysis 1.10

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 10 Wound dehiscence.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 11 Fistula.
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Analysis 1.11

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 11 Fistula.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 12 Bowel obstruction.
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Analysis 1.12

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 12 Bowel obstruction.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 13 Leg oedema.
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Analysis 1.13

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 13 Leg oedema.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 14 Deep venous thrombosis.
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Analysis 1.14

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 14 Deep venous thrombosis.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 15 Symptomatic ascites.
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Analysis 1.15

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 15 Symptomatic ascites.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 16 Blood transfusion.
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Analysis 1.16

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 16 Blood transfusion.

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 17 Duration of surgery (minute).
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Analysis 1.17

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 17 Duration of surgery (minute).

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 18 Return of bowel sounds (day).
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Analysis 1.18

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 18 Return of bowel sounds (day).

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Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 19 Hospital stay (day).
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Analysis 1.19

Comparison 1 Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy, Outcome 19 Hospital stay (day).

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Summary of findings for the main comparison. Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for gynaecological malignancies

Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for gynaecological malignancies

Patient or population: Women with gynaecological malignancies
Settings: hospital
Intervention: retroperitoneal drainage versus no drainage after pelvic lymphadenectomy

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy

Short‐term lymphocyst formation: both asymptomatic and symptomatic within 4 weeks after surgery

Study population

RR 0.76
(0.04 to 13.35)

204
(2 studies)

⊕⊕⊕
moderate1

172 per 1000

131 per 1000
(7 to 1000)

Medium‐risk population

161 per 1000

122 per 1000
(6 to 1000)

Short‐term lymphocyst formation: symptomatic within 4 weeks after surgery

Study population

RR 3.25
(1.26 to 8.37)

237
(2 studies)

⊕⊕⊕⊕
high

43 per 1000

140 per 1000
(54 to 360)

Medium‐risk population

36 per 1000

117 per 1000
(45 to 301)

Short‐term lymphocyst formation: both asymptomatic and symptomatic at 8 weeks after surgery

Study population

RR 0.72
(0.3 to 1.71)

180
(2 studies)

⊕⊕⊕⊕
high

112 per 1000

81 per 1000
(34 to 192)

Medium‐risk population

110 per 1000

79 per 1000
(33 to 188)

Long‐term lymphocyst formation: both asymptomatic and symptomatic at 12 months after surgery

Study population

RR 1.48
(0.89 to 2.45)

232
(1 study)

⊕⊕⊕⊕
high

171 per 1000

253 per 1000
(152 to 419)

Medium‐risk population

171 per 1000

253 per 1000
(152 to 419)

Long‐term lymphocyst formation: symptomatic at 12 months after surgery

Study population

RR 7.12
(0.89 to 56.97)

232
(1 study)

⊕⊕⊕⊕
low1,2

9 per 1000

64 per 1000
(8 to 513)

Medium‐risk population

9 per 1000

64 per 1000
(8 to 513)

Febrile morbidity

Study population

RR 1.76
(0.87 to 3.55)

571
(4 studies)

⊕⊕⊕⊕
high

39 per 1000

69 per 1000
(34 to 138)

Medium‐risk population

39 per 1000

69 per 1000
(34 to 138)

Pelvic infection

Study population

RR 0.42
(0.11 to 1.62)

571
(4 studies)

⊕⊕⊕
moderate2

18 per 1000

8 per 1000
(2 to 29)

Medium‐risk population

19 per 1000

8 per 1000
(2 to 31)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Wide confidence interval.
2Small number of events in the analysis.

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Summary of findings for the main comparison. Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for gynaecological malignancies
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Comparison 1. Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Short‐term lymphocyst formation: both asymptomatic and symptomatic within 4 weeks after surgery Show forest plot

2

204

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.04, 13.35]

2 Short‐term lymphocyst formation: symptomatic within 4 weeks after surgery Show forest plot

2

237

Risk Ratio (M‐H, Fixed, 95% CI)

3.25 [1.26, 8.37]

3 Short‐term lymphocyst formation: both asymptomatic and symptomatic at 8 weeks after surgery Show forest plot

2

180

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.30, 1.71]

4 Short‐term lymphocyst formation: both asymptomatic and symptomatic at 12 weeks after surgery Show forest plot

1

83

Risk Ratio (M‐H, Fixed, 95% CI)

0.13 [0.01, 2.38]

5 Long‐term lymphocyst formation: both asymptomatic and symptomatic at 12 months after surgery Show forest plot

1

232

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [0.89, 2.45]

6 Long‐term lymphocyst formation: symptomatic at 12 months after surgery Show forest plot

1

232

Risk Ratio (M‐H, Fixed, 95% CI)

7.12 [0.89, 56.97]

7 Febrile morbidity Show forest plot

4

571

Risk Ratio (M‐H, Fixed, 95% CI)

1.76 [0.87, 3.55]

8 Pelvic infection Show forest plot

4

571

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.11, 1.62]

9 Wound infection Show forest plot

2

334

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.07, 1.18]

10 Wound dehiscence Show forest plot

2

237

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.14, 6.89]

11 Fistula Show forest plot

3

471

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.34, 4.57]

12 Bowel obstruction Show forest plot

2

334

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.12]

13 Leg oedema Show forest plot

1

137

Risk Ratio (M‐H, Fixed, 95% CI)

2.71 [0.75, 9.77]

14 Deep venous thrombosis Show forest plot

2

371

Risk Ratio (M‐H, Fixed, 95% CI)

2.02 [0.38, 10.84]

15 Symptomatic ascites Show forest plot

1

137

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.12, 3.92]

16 Blood transfusion Show forest plot

2

237

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.68, 1.21]

17 Duration of surgery (minute) Show forest plot

1

100

Mean Difference (IV, Fixed, 95% CI)

4.20 [‐15.35, 23.75]

18 Return of bowel sounds (day) Show forest plot

1

100

Mean Difference (IV, Fixed, 95% CI)

0.14 [‐0.11, 0.39]

19 Hospital stay (day) Show forest plot

2

200

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.34, 0.74]
Figuras y tablas -
Comparison 1. Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy
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