After node dissection, lymphoceles leak at Cloquet's node

Design

Prospective single-centre imaging study

Population

40 men with 45 symptomatic lymphoceles after extended or salvage PLND

Primary outcome

Anatomical site of lymphatic leakage

Effect

Cloquet region in 42/43 leaks (98%, 95% CI 88 to 100); embolisation success 84%

Lymphocele is the main morbidity argument against extended pelvic lymph node dissection at prostatectomy. A prospective single-centre Journal of Urology study used lymphangiography in 40 men with 45 symptomatic lymphoceles after extended or salvage dissection between 2018 and 2024.

Active leakage was found in 43 of 45 lymphoceles, and 42 of those 43 leaks (98%) arose in the Cloquet region at the femoral canal. Most single-site leaks came from afferent vessels draining into an excised Cloquet's node. Lymphatic leak embolisation succeeded clinically in 84%.

The authors note that Cloquet's node rarely harbours metastasis in prostate cancer and propose sparing it with careful lymphostasis. That is plausible but untested: this study mapped leaks in men who already had lymphoceles and did not compare techniques.

• Almost all leaks causing symptomatic lymphoceles arose in the Cloquet region.
• Consider meticulous sealing or clipping of lymphatics at the distal limit of dissection near the femoral canal.
• Lymphangiography with embolisation resolved most symptomatic lymphoceles.
• Cloquet-sparing dissection is a hypothesis that needs comparative testing.

Why it matters

Pinpointing where leaks start may let surgeons keep the oncological benefit of extended dissection with less morbidity.

Don't overread it

The study described leak sites in affected men; it did not show that sparing Cloquet's node prevents lymphoceles.

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