title: Radio guided radical prostatectomy: evaluation of feasibility, safety and clinical outcomes.
abstract: BACKGROUND
  The standard surgical treatment of PCa consists of radical prostatectomy (RP). Lymphadenectomy with removal of the sentinel lymph node (SLN) is now evolving towards the concept of radio guided surgery as an instrument for the removal of the lymph nodes of primary drainage.
  
  
  METHODS
  From October 2012 to September 2013 laparotomic SLN dissection was performed in 43 patients during standard open radical prostatectomy. Twenty hours before surgery, 240 MBq of 99mTc nanocolloid were injected into the prostate gland under transrectal ultrasound guidance. A planar scintigraphy and a SPET/CT scan were performed 1-2 hours after the injection. Intraoperatively, all LNs detected by gamma-probe with an activity significantly higher than background were removed and classified as SLNs. We evaluated operative time, complications, postoperative outcomes and costs of the procedures of patients who underwent radio guided surgery. We measured radioactive exposure rates.
  
  
  RESULTS
  The intraoperative detection of SLNs occurred in all 43 patients, while the scintigraphic localization was observed in 42/43 patients. A total of 77 SLNs were found, at histopathological analysis 7/77 SLNs resulted positive for metastases (4/43 patients): 3 were in the obturator fossa while the remaining SLNs were in the internal iliac chain (1), common iliac chain (1), external iliac chain (2). Global radiation exposure was not significant.
  
  
  CONCLUSIONS
  Our preliminary data confirm the feasibility and the safety of SLN biopsy in nodal staging of PCa. The intraoperatively SLN detection rate resulted 100%. In 3 patients (7%) a micrometastases was found outside of obturator fossa in a not routinely sampled site.
authors.affiliation: Urology Department, San Gerardo Hospital, University of Milano‑Bicocca, Monza, Italy - angelica_grasso@yahoo.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Grasso
authors.forename: Salvatore
authors.initials: S
authors.lastname: Blanco
authors.forename: Angelica A C
authors.initials: AA
authors.lastname: Grasso
authors.forename: Andrea
authors.initials: A
authors.lastname: Crespi
authors.forename: Elena
authors.initials: E
authors.lastname: De Ponti
authors.forename: Nicola
authors.initials: N
authors.lastname: Zucchini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bovo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Arosio
authors.forename: Simone
authors.initials: S
authors.lastname: Marcelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D002277:Carcinoma / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D005240:Feasibility Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D017430:Prostate-Specific Antigen