Abstract:Objective: To demonstrate the clinical experience with laparoscopic pelvic lymph node dissection for 41 prostate cancer patients. Methods: Between March 2009 and December 2012, the clinical data of 41 consecutive patients treated with laparoscopic radical prostatectomy and pelvic lymph node dissection by a single surgeon were analyzed retrospectively. All patients were divided into two groups according to preoperative PSA, Gleason score and clinical stage. The lymph node-positive ratio was compared between two groups statistically. Results: The average operative time was (35.0±5.8) min. The average estimated bleeding volume during lymphadenectomy was (42.7±19.9) mL. The average number of lymph nodes dissected was (6.9±1.8). The lymph node-positive ratio in PSA>20 μg/L group and Gleason score >7 group was 23.7% and 20.0% respectively, which was higher than in low-risk control group significantly. 26.8% (11 cases) of patients had drainage more than 7 days. Conclusions: The lymph node-positive ratio was higher in high-risk clinically organ confined prostate cancer patients. Laparoscopic pelvic lymph node dissection was recommended to perform in those patients together with radical prostatectomy.
[1] Joslyn SA, Konety BR. Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology, 2006,68(1):121-125. [2] Boorjian SA, Thompson RH, Siddiqui S, et al. Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era. J Urol, 2007,178(3Pt1):864-870. [3] 李普,殷长军,邵鹏飞,等.改良经腹腔途径腹腔镜下前列腺癌根治术285例临床研究.中华泌尿外科杂志,2012,33(10):749-752. [4] Joung JY, Cho IC, Lee KH. Role of pelvic lymph node dissection in prostate cancer treatment. Korean J Urol, 2011,52(7):437-445. [5] Engel J, Bastian PJ, Baur H, et al. Survival benefit of radical prostatectomy in lymph node-positive patients with prostate cancer. Eur Urol, 2010,57(5):754-761. [6] Pierorazio PM, Gorin MA, Ross AE, et al. Pathological and oncologic outcomes for men with positive lymph nodes at radical prostatectomy: The Johns Hopkins Hospital 30-year experience. Prostate, 2013,73(15):1673-1680. [7] Gakis G, Boorjian SA, Briganti A, et al. The role of radical prostatectomy and lymph node dissection in lymph node-positive prostate cancer: a systematic review of the literature. Eur Urol, 2014,66(2):191-199. [8] Daimon T, Miyajima A, Maeda T, et al. Does pelvic lymph node dissection improve the biochemical relapse-free survival in low-risk prostate cancer patients treated by laparoscopic radical prostatectomy? J Endourol, 2012,26(9):1199-1202. [9] Abdollah F, Suardi N, Gallina A, et al. Extended pelvic lymph node dissection in prostate cancer: a 20-year audit in a single center. Ann Oncol, 2013,24(6):1459-1466. [10] Danuser H, Di Pierro GB, Stucki P, et al. Extended pelvic lymphadenectomy and various radical prostatectomy techniques: is pelvic drainage necessary? BJU Int, 2013,111(6):963-969. [11] Touijer K, Fuenzalida RP, Rabbani F, et al. Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging or increased morbidity? BJU Int, 2011,108(3):372-377. [12] Bivalacqua TJ, Pierorazio PM, Gorin MA, et al. Anatomic extent of pelvic lymph node dissection: impact on long-term cancer-specific outcomes in men with positive lymph nodes at time of radical prostatectomy. Urology, 2013,82(3):653-658. [13] Liss MA, Palazzi K, Stroup SP, et al. Outcomes and complications of pelvic lymph node dissection during robotic-assisted radical prostatectomy. World J Urol, 2013,31(3):481-488. [14] Suardi N, Larcher A, Haese A, et al. Indication for and extension of pelvic lymph node dissection during robot-assisted radical prostatectomy: an analysis of five European institutions. Eur Urol, 2014,66(4):635-643. [15] 肖文军,叶定伟,姚旭东,等.前列腺癌根治术中盆腔淋巴结清扫的意义及并发症防治.中华泌尿外科杂志,2010,31(11):770-773.