Lymph Cyst After Robotic-assisted Lateral Lymph Node Dissection for Rectal Cancer Treated With Lymphangiography: A Case Report.

Abstract

Background/aim: With the increasing use of robotic-assisted surgery, postoperative lymphatic leakage has become a more frequent challenge. Lymph cysts following lateral lymph node dissection (LLND) for rectal cancer can lead to complications, such as infection, compression of adjacent structures, and impaired lymphatic drainage. Conservative treatments, including percutaneous drainage, are often used, but refractory cases require alternative strategies.

Case report: A 78-year-old woman underwent robotic-assisted abdominoperineal resection with right LLND for lower rectal cancer. She was discharged on postoperative day 12 but developed right lower abdominal pain on day 7 after discharge. Computed tomography revealed a fluid collection in the LLND area, diagnosed as a lymph cyst. Despite computed tomography-guided percutaneous drainage, the output remained high, and symptoms persisted. On hospital day 18, lymphangiography was performed using Lipiodol via right inguinal lymph node puncture. Within 3 days, the drainage output significantly decreased, and her symptoms improved.

Conclusion: Lymphangiography with Lipiodol is a minimally invasive and effective treatment for refractory lymph cysts following LLND. As robotic-assisted surgery becomes more common, understanding and managing postoperative lymphatic complications are increasingly important.