Danuser 2013

Extent of dissection superior to Cloquet's node; obturator, external iliac and hypogastric nodes excised in extended pelvic lymphadenectomy, no inguinal lymph node dissection

Danuser studied 331 consecutive patients undergoing extended pelvic lymph node dissection to include obturator, external iliac and hypogastric lymph nodes, following radical prostatectomy. Their patient groups were divided into three series: the first series (132 participants) underwent open radical prostatectomy with two 'easy flow' drains placed in the right and left obturator fossae, with randomisation by coin toss just after surgery into two groups: Group 1 (66 participants) had shortening of the drains on post‐operative days three and five, with drain removal at day seven. Group 2 (66 participants) had their drains removed on post‐operative day one. Drain removal was delayed across both groups, if required, until drainage volume was less than 100 mL over 24 hours. The next 73 consecutive patients (Group 3) underwent open radical prostatectomy with no drain inserted. The final 126 consecutive patients (Group 4) were treated with robot‐assisted radical prostatectomy, with no drain inserted. Seroma (asymptomatic and symptomatic) occurred in 6% of Group 1, 12% of Group 2, 10% of Group 3 and 3% of Group 4. Significant differences were reported between Groups 2 and 4 (P value 0.02). There were no wound complications noted in any of the groups, however, drain insertion necessitated two to five days longer in hospital, although the authors did note that "drain management, care and removal could also be carried out on an outpatient basis".

Franchi 1997

Pelvic drainage following hysterectomy and dissection of common external iliac and obturator nodes, no inguinal lymph node dissection

Franchi 2007

Pelvic drainage following hysterectomy and pelvic lymph node dissection, no inguinal lymph node dissection.

Franchi studied 234 patients following radical hysterectomy and pelvic lymph node dissection with 117 patients randomised (no details given on randomisation methods) to insertion of two suction drains, placed in the retroperitoneal fossa via a vaginal or abdominal route. Drains were removed when drainage volume was less than 50 mL over 24 hours. There was no difference in incidence of asymptomatic or symptomatic seroma between the two trial arms and no difference for other post‐operative complications.

Lopes 1995

Pelvic drainage following hysterectomy and external iliac, internal iliac and obturator node dissection, no inguinal lymph node dissection.

Lopes studied 100 consecutive patients following radical hysterectomy and bilateral pelvic lymph node dissection of the external iliac, internal iliac and obturator nodes. Fifty‐one patients were randomised, using numbered envelopes, to insertion of a suction drain into each pelvic sidewall. Drains were removed when drainage volume was less than 100 mL over 24 hours.The incidence of seroma in the drained group that was revealed by clinical examination (5.9%) and ultrasound (15.6%) did not different significantly from the undrained group for both clinical examination (6.1%) and ultrasound (17.4%), leading the authors to conclude that there "appears to be no advantage to the routine use of pelvic suction drainage following radical hysterectomy and pelvic lymphadenectomy".

Morice 2001

Pelvic and para‐aortic lymphadenectomy, no inguinal node dissection

Ozdemir 2013

Extent of dissection superior to Cloquet's node; extended pelvic lymphadenectomy, no inguinal node dissection.

Ozdemir studied 58 patients with bladder carcinoma, treated surgically with radical cystectomy, extended bilateral pelvic lymph node dissection and orthotopic bladder pouch substitution. Patients underwent pseudo‐randomisation by coin‐tossing, with 22/58 given a pelvic drain, which was removed when the drainage was less than 100 mL over 24 hours. There were no statistically significant differences observed between groups for length of hospital stay, or early or late postoperative complications, including wound infection, haematoma and seroma.

Patsner 1995

Not an RCT; pelvic drainage following hysterectomy and pelvic lymphadenectomy, no inguinal lymph node dissection.

Patsner studied 120 consecutive patients with invasive cervical cancer who underwent radical abdominal hysterectomy and bilateral pelvic lymph node dissection, with removal of common iliac and pelvic lymph nodes. The first 60 patients had bilateral Jackson‐Pratt closed suction drains placed in the retroperitoneal spaces, and the next 60 patients had no drains inserted. No difference in rates of post‐operative infection or seroma were reported between groups (no statistical analysis presented).

Youssef 2005

Groin dissection for vascular reconstruction, no lymph nodes excised