Risk Factors for Lymphatic Leakage Following Radical Cystectomy and Pelvic Lymph Node Dissection in Patients with Muscle-Invasive Bladder Cancer

Abstract Background Lymphatic leakage is a common complication after radical cystectomy and pelvic lymph node dissection (PLND) for muscle-invasive bladder cancer (MIBC).This study aimed to investigate the risk factors contributing to postoperative lymphatic leakage in patients with MIBC. Materials and Methods A total of 534 patients undergoing radical cystectomy and PLND were enrolled in the retrospective study at Peking University Third Hospital from January 2010 to July 2023. Patients were categorized into lymphatic leakage(n = 254)and non-leakage groups (n = 280) and compared demographic, preoperative, intraoperative, pathological, and postoperative factors. Multivariate logistic regression found factors that predict lymphatic leakage. Spearman correlation was used to analyze the relationship between lymph leakage ratio and risk factors. Results Patients with lymphatic leakage had significantly higher rates of receiving extended PLND (19.7% vs 11.4%, p = 0.008), higher number of total lymph nodes removed (median 11 vs 8, p < 0.001), longer hospital stays (median 13 vs 11 days, p < 0.001), higher rates of postoperative hypoalbuminemia (56.7% vs 36.4%, p < 0.001) and fever (14.2% vs 8.6%, p = 0.04) compared to the non-leakage group. On multivariate analysis, higher number of lymph nodes removed (OR 3.278, 95% CI 1.135–9.471, p = 0.028) were found to be significant independent risk factors for lymphatic leakage. A significant positive correlation was observed between the number of lymph nodes excised and lymphatic leakage rate (R = 0.456, p = 0.013). Conclusions The increased number of lymph nodes dissected is associated with a heightened risk of lymphatic leakage following radical cystectomy for MIBC.