Outcomes

More than 20 publications since 1992 have addressed the outcomes of laparoscopic pelvic lymph node dissection (19-26). Historically, laparoscopic pelvic lymph node dissection had been compared to open pelvic lymph node dissection and minilaparotomy pelvic lymph node dissection, but currently staging pelvic lymph node dissection is rarely performed as an independent procedure. Thus, the majority dissections are performed through a midline incision during retropubic prostatectomy or laparoscopically with ports placed in anticipation of performing radical prostatectomy.

In general, the efficacy of laparoscopic pelvic lymph node dissection is comparable to open pelvic lymph node dissection.

Parra et al. (22) demonstrated a comparable yield of lymph nodes (10.7 vs. 11) for laparoscopic and open pelvic lymph node dissection, respectively. Kerbl et al. (20) compared 30 patients undergoing laparoscopic pelvic lymph node dissection with 16 patients undergoing open pelvic lymph node dissection. Laparoscopy was associated with a longer operating time (199 minutes vs. 102 minutes), and a 13% complication rate. Herrell et al. (24) compared laparoscopic pelvic lymph node dissection to open and minilaparot-omy pelvic lymph node dissection. The three groups had equivalent staging efficacy, but laparoscopic and minilaparotomy pelvic lymph node dissection were associated with decreased length of hospital stay and complications. Laparoscopic pelvic lymph node dissection required a longer operative time.

Stone et al. (25) compared modified (N = 150) with extended laparoscopic pelvic lymph node dissection (N = 39). This study revealed the feasibility of laparoscopic extended pelvic lymph node dissection for prostate cancer wherein the obturator, hypogastric, common and external iliac nodes were retrieved. However, the extended group had an increased complication rate, 36% versus 2%. Presently, limited pelvic lymph node dissection for laparoscopic radical prostatectomy adds approximately 30 minutes to the operating time.

The rate of complications associated with laparoscopic pelvic lymph node dissection ranges from 0% to 22% as opposed to 0% to 13% for open pelvic lymph node dissection (19-26). However, these reports were published between 1992 and 1997 and with greater laparoscopic experience, one would anticipate diminished complication rates.

In a series of 100 consecutive laparoscopic pelvic lymph node dissection, the rate of complication was 25% for the first 20 cases and 5% for the subsequent 80 cases (21). Complications in contemporary series compare favorably with prior published open series (27).

SUMMARY: PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER

■ Currently, controversy regarding pelvic lymph node dissection for prostate cancer is focused on the issue of which patients should have a pelvic lymphadenectomy and whether it should be limited or extended, rather than laparoscopic versus open.

■ The development of nomograms and preoperative predictive models have aided in identifying low risk patients, decreasing the necessity for unnecessary pelvic lymph node dissection.

■ Further studies are required to clarify the exact extent of lymph node dissection in higher risk patients.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment