# Association of fluid management during robotic-assisted radical laparoscopic prostatectomy with early surgical clinical outcomes: a risk factor for lymphoceles

## TL;DR

This study finds that fluid management during prostate surgery is linked to lymphocele formation, a finding that could help reduce complications.

## Contribution

The study identifies intraoperative fluid management as a modifiable risk factor for lymphoceles after robotic prostatectomy.

## Key findings

- Higher fluid administration is significantly associated with lymphocele formation (p < 0.001).
- A fluid dosage threshold of 7.73 mL/kg/h confirms the association with lymphoceles via propensity score matching.
- Fluid management is a modifiable factor that may prevent symptomatic lymphoceles in larger patient groups.

## Abstract

Robotic-assisted radical laparoscopic prostatectomy (RARP) is a standard treatment for localized prostate cancer. While surgical factors are often considered, the impact of anesthesiological factors, particularly intraoperative fluid management, on postoperative outcomes remains understudied. This study aimed to evaluate the relationship between fluid management and early complications after RARP. The study retrospectively analyzed data from 285 patients who underwent RARP at a single institution between 2019 and 2021. Fluid administration was quantified as corrected fluid dosage (mL/kg/h) and total fluid balance. Postoperative complications within 30 days, including anastomotic leakage and lymphocele formation, were assessed. Multivariable modeling and propensity score matching were used to evaluate the association between fluid management and lymphoceles. We found no significant association between fluid management and major complications (Clavien–Dindo grade ≥ II) or anastomotic leakage. However, a significant association was observed between higher fluid administration and lymphocele formation (p < 0.001). In the generalized linear model, the association of fluid dosage with lymphocele occurrence was confirmed (p = 0.002), independently of a peritoneal flap procedure. At a fluid dosage threshold of 7.73 ml/kg/h, propensity score matching confirmed the association. While major complications following RAPR are rare, generous fluid management was associated with a higher incidence of lymphocele formation. While these mostly remained asymptomatic, this finding suggests that intraoperative fluid management is a modifiable risk factor for lymphoceles and may prevent symptomatic lymphoceles as major complications in larger collectives. Moreover, it provides new insights into their potential pathogenesis.

The online version contains supplementary material available at 10.1007/s11701-025-02579-9.