Results of laparoscopic pelvic lymphadenectomy in patients at high risk for nodal metastases from prostate cancer.
BACKGROUND
Laparoscopic pelvic lymphadenectomy (LPLND) can be performed safely and with minimal morbidity in the staging of prostate cancer. Its utility in evaluating patients at high risk for metastatic disease before primarily nonsurgical treatment modalities was evaluated.


METHODS
Twenty-four consecutive patients who underwent LPLND between June 1993 and July 1996 were studied. These patients were considered poor surgical candidates based on several risk factors, as follows: elevation of serum PSA >20 in 19 patients (79%); elevation of serum acid phosphatase in 4 patients (17%); digital rectal examination findings indicative of extraprostatic extension or seminal vesical involvement in 14 patients (58%); and poorly differentiated tumors on prostate biopsy in 19 patients (79%). Nineteen patients (79%) had two or more of these risk factors. Median PSA for the entire series of patients was 35.2 ng/mL (range 7.9 to 133 ng/mL), and median Gleason score was 7 (range 5 to 9). Preoperative CT or MRI was negative for pelvic lymph node metastases in 17 of 23 patients (79%), and bone scan was negative in all 24 patients.


RESULTS
Unilateral (n = 2) or bilateral (n = 22) LPLND was performed in all patients. Six patients (25%) had lymph node metastases detected laparoscopically. Five of the six patients had palpable extraprostatic extension (T3a/b) or invasion of a seminal vesical (T3c), and in four of these patients the site of the metastatic lymph nodes was ipsilateral to the palpable prostate abnormality. None of the risk factors was independently predictive of lymph node metastases within this series of patients. An average of 10.8 +/- 6.5 lymph nodes was removed at a mean operative time of 174 +/- 10 minutes for patients undergoing bilateral LPLND. Estimated blood loss was minimal for 20 of 22 patients (92%) undergoing LPLND alone, and there were no complications requiring open exploration. Mean postoperative hospital stay was 1.2 +/- 0.5 days for patients undergoing LPLND alone.


CONCLUSIONS
LPLND can be used efficiently to identify patients with nodal metastases from select high-risk patients. This, in turn, can exclude such patients from noncurative local and regional therapy.
Kava
B R
BR
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Dalbagni
G
G
Conlon
K C
KC
Russo
P
P
D000135:Acid Phosphatase / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D016063:Blood Loss, Surgical; D001842:Bone and Bones / Q000000981:diagnostic imaging; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D005544:Forecasting; D006760:Hospitalization; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010388:Pelvis / Q000601:surgery*; D010808:Physical Examination; D011183:Postoperative Complications; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011877:Radionuclide Imaging; D012307:Risk Factors; D012449:Safety; D012669:Seminal Vesicles / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor; D000135:Acid Phosphatase; D017430:Prostate-Specific Antigen