A new minimally invasive open pelvic lymphadenectomy surgical technique for the staging of prostate cancer.
We report a new method for lymphadenectomy, the minilaparotomy (inguinal) pelvic lymph node dissection (MLPLND), and compare it with laparoscopic pelvic lymph node dissection (LPLND) in terms of cost, effectiveness, operation time and morbidity. We reviewed a series of 111 consecutive patients: 51 had MLPLND and 60 had LPLND. All patients had proved adenocarcinoma of the prostate by biopsy. Of the MLPLND patients, only 1 had to stay overnight in the hospital, and all left within 24 hours. Pelvic lymphadenectomy consisted of nodal removal along the internal iliac vessels and the external iliac vein, and nodes of the obturator foramen. A total of 14% of the patients had disease involving the lymph nodes. The cost of MLPLND was 50% of the cost of LPLND, with no interoperative or postoperative morbidity. This new operation can be performed thoroughly an inexpensively in approximately 35 minutes, with little or no morbidity. Since the drawbacks of laparoscopic techniques associated with instrument costs and the learning curve for this technically difficult operation are eliminated, staging pelvic lymphadenectomy can be performed routinely on a wider variety of patients with potential metastatic disease. Currently, we recommend MLPLND to any patient with a tumor of Gleason score 7 or higher or a serum prostate-specific antigen value of 15 ng/mL or higher.
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School of Medicine, University of California, San Diego, USA.
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W O
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Brown
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Seid
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Allen
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D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D008197:Lymph Node Excision / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods; D009367:Neoplasm Staging; D010388:Pelvis; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D013997:Time Factors