Initial Experience with Staging Laparoscopic Pelvic Lymphadenectomy Performed at the Time of Radical Retropubic Prostatectomy for Prostatic Adenocarcinoma

摘要

Laparoscopic pelvic lymphadenectomy on 47 consecutive patients at the time of radical retropubic prostatectomy for adenocarcinoma was performed to assess the adequacy of laparoscopic node dissections and the feasibility of performing such laparoscopic lymphadenectomy concomitantly with radical prostatectomy. Nodal packets were obtained laparoscopically bilaterally and sent for pathologic examination separately from any surgically obtained nodes. The average number of nodes obtained during laparoscopy was 10 ± 7.04. As operator experience improved, the number of nodes increased to an average of 11.6 for the last ten node dissections. Likewise, the number of nodes remaining after laparoscopic lymph node dissection fell progressively to an average of 1.7 during the last ten lymphadenectomies. In the preceding 30 standard pelvic lymphadenectomies performed by the authors (control series) an average of 13.4 ± 6.72 nodes were removed surgically prior to radical prostatectomy. There were no positive nodes found at the time of surgical exploration that had been missed by laparoscopic dissection (false negative). Two of forty-five patients had positive nodes at the time of laparoscopic dissection, and 1 of 30 control patients had positive nodes at the time of surgical dissection. Average daily wound drainage was significantly higher in laparoscopy patients, and there was a significant increase in the mean operative time in the laparoscopy group (226v147 minutes). However, rapidity improved with experience, and the average total time for the last ten laparoscopic lymph node dissections was 78 minutes. The average total operative time for laparoscopic lymph node dissection and prostatectomy was 208 minutes, v an average for the control cohort of 154 minutes. The hospital stay was been significantly different for the laparoscopic group. Laparoscopic pelvic lymphadenectomy appears to be an appropriate option for staging prostatic adenocarcinoma, with production of adequate node packets. The authors are refining criteria for the routine performance of this procedur