title: Laparoscopic extended pelvic lymph node dissection for high-risk prostate cancer.
abstract: BACKGROUND
  Recently, some controversy has arisen as to whether pelvic lymphadenectomy is still necessary for patients with prostate cancer who are undergoing radical prostatectomy. We prospectively evaluated the results and morbidity of laparoscopic extended pelvic lymph node dissection in patients with high-risk prostate cancer defined as a serum prostate-specific antigen (PSA) level greater than 10 ng/mL or preoperative biopsy Gleason score of 7 or more.
  
  
  METHODS
  In 123 consecutive patients with clinically organ-confined high-risk prostate cancer, laparoscopic extended pelvic lymphadenectomy was performed before laparoscopic radical prostatectomy. The boundaries of the pelvic lymph node dissection were the bifurcation of the common iliac artery superiorly, the node of Cloquet inferiorly, the external iliac vein laterally, and the bladder wall medially. Preparation was done with bipolar forceps and scissors, with meticulous coagulation of all lymphatic tissue. The mean PSA level was 14.8 ng/mL (range 1.5 to 43.4). The mean number of lymph nodes removed was 21 (range 9 to 55). A total of 21 patients (17%) had lymph node metastases. The overall complication rate was 4%.
  
  
  CONCLUSIONS
  Laparoscopic extended pelvic lymph node dissection is safe and effective. The results and morbidity are equivalent to those of open surgery, with the advantage of a minimally invasive operative technique.
authors.affiliation: Department of Urology, University Hospital Basel, Basel, Switzerland.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Wyler
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
authors.forename: Hans-Helge
authors.initials: HH
authors.lastname: Seifert
authors.forename: Robin
authors.initials: R
authors.lastname: Ruszat
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Forster
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Gasser
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D010388:Pelvis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen