[Comparison of the morbidity between limited and extended pelvic lymphadenectomy during laparoscopic radical prostatectomy].
OBJECTIVE
To compare the morbidity of limited pelvic lymphadenectomy to extended lymphadenectomy in patients undergoing LRP (Laparoscopic Radical Prostatectomy) for clinically localized prostate cancer.


METHODS
We performed a prospective monocentric study focused on 303 consecutive patients having a pelvic lymphadenectomy during LRP from June 2000 to April 2010. One hundred and seventy six patients had a limited pelvic lymphadenectomy (June 2000-June 2006, group 1). One hundred and twenty seven patients had an extended pelvis lymphadenectomy (June 2006-April 2010, group 2) including two sub-groups according to the lateral limit of the procedure i.e. with (group 2a, 60 patients) or without dissection of the lateral side of the iliac artery (group 2b, 67 patients).


RESULTS
Preoperative data (age, BMI, cTNM, Gleason score and PSA) were comparable between the groups. The number of lymph nodes and the incidence of metastatic lymph nodes were lower in group 1 (6,7 lymph nodes and 5,7%) compared to group 2 (a+b) (15.6 lymph nodes and 18.9%) (P=0.001 and P=0.0004). However, there was no difference between groups 2a and 2b (15.4 and 16.7% vs 15,8 and 20.8% P=0.65 respectively). There were more complications in the extended lymphadenectomy group compared to the limited procedure (35.4% vs 14.2%, P=0.0001), in particular more lymphatic complications (27.5% vs 10.2% P=0.0001) and lymphoedema (LO) (15.7% vs 0.6% P=0.00001). However the lymphorhea (LR) and lymphocele (LC) rate was not different (P=0.11 and P=0.17). All complications were mainly of low Clavien's classification grade (1+2) whatever the group of lymphadenectomy. The hospital stay was not increased in group 2a or 2b in regard to group 1. The rate of LR and LC was higher in group 2a than in group 1 (P=0.02 and P=0.05) but not between group 2b and 1 (P=0.81 and P=0.47).


CONCLUSIONS
Our study showed a higher rate of complications after extended pelvic lymphadenectomy but of low grade in most cases. Moreover the lateral dissection sparing the lateral side of the iliac artery reduced the risk of lymphatic complications without decreasing the number of lymph nodes removed and the rate of metastasis.
Service d'urologie, CHRU de Brest, 29200 Brest, France.
B
B
Rousseau
Laboratoire d'anatomopathologie, CHRU de Brest, 29200 Brest, France.
L
L
Doucet
Service d'urologie, CHRU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France.
M-A
MA
Perrouin Verbe
Service d'urologie, CHRU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France.
G
G
Papin
Service d'urologie, CHRU de Brest, 29200 Brest, France.
A
A
Erauso
Service d'urologie, CHRU de Brest, 29200 Brest, France.
V
V
Joulin
Service d'urologie, CHRU de Brest, 29200 Brest, France.
C
C
Deruelle
Service d'urologie, CHRU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France.
A
A
Valeri
Service d'urologie, CHRU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France. Electronic address: georges.fournier@chu-brest.fr.
G
G
Fournier
D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*
Cancer de prostate localisé; Clinically localized prostate cancer; Curage pelvien; Lymphocele; Lymphocèle; Lymphoedema; Lymphorrhea; Lymphorrhée; Lymphœdème; Morbidity; Morbidité; Pelvic lymphadenectomy