Laparoscopic sentinel lymph node dissection--a novel technique for the staging of prostate cancer.
OBJECTIVE
Pelvic lymph node metastases indicate a poor prognosis for prostate cancer patients. The aim of this study was to evaluate the suitability of laparoscopic radioisotope guided sentinel lymph node (SLN) dissection in staging of prostate carcinoma.


METHODS
28 patients with prostate cancer and intermediate or high risk for lymph node metastases considered for external beam radiotherapy underwent laparoscopic pelvic lymphadenectomy at our institution. For visualization of individual SLN distribution, an image fusion system consisting of a gamma-camera with integrated X-ray tube was used. During laparoscopic lymphadenectomy, SLN were identified using a laparoscopic gamma probe.


RESULTS
Preoperative imaging and laparoscopic gamma probe allowed an excellent delineation of SLN. 57% (preoperative imaging) as well as 48% (intraoperative measurements) of SLN were found outside the obturator fossa. All SLN were removed successfully without intra- or postoperative complications. Despite extended lymphadenectomy, no significant lymphocele appeared. 10 lymph node metastases were found in 7 out of the 31 patients (23%) with 3 of the 10 metastases lying outside the obturator fossa representing the standard lymphadenectomy area.


CONCLUSIONS
The present data demonstrate that laparoscopic SLN dissection is an excellent minimally invasive and technically feasible tool for staging of intermediate and high risk prostate cancer.
Corvin
Stefan
S
Department of Urology, Eberhard-Karls-University, Tuebingen, Germany. stefan.corvin@med.uni-tuebingen.de
Schilling
David
D
Eichhorn
Kai
K
Hundt
Ilse
I
Hennenlotter
Joerg
J
Anastasiadis
Aristotelis G
AG
Kuczyk
Markus
M
Bares
Roland
R
Stenzl
Arnulf
A
D000368:Aged; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D010535:Laparoscopy / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional