無淋巴或遠端轉移之攝護腺癌病患使用靛青綠螢光淋巴造影術於達文西輔助攝護腺切除中之骨盆淋巴廓清術

Pelvic Lymph Node Dissection Using Indocyanine Green Fluorescence Lymphangiography in Robotic Assisted Radical Prostatectomy for Non-lymph Node or Distant Metastasis Prostate Cancer Patients.

莊毓峰¹、呂謹亨¹、林益聖¹、黃立華¹、翁瑋駿¹、張佑剛²、陳鴻霖²、許兆畬¹、童敏哲¹、歐宴泉¹

童綜合醫院 外科部泌尿科¹，醫學研究部²

Yu-Feng Chuang¹, Chin-Heng Lu¹, Lin-Yi Shang¹, Li-Hua Huang¹, Wei-Chun Weng¹, Yu-Kang Chang², Hung-Lin Chen², Chao-Yu Hsu¹, Min-Che Tung¹, Yen-Chuan Ou¹

¹Divisions of Urology, Department of Surgery, Tungs’ Taichung Metroharbor Hospital, ²Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan

Purpose:

The utility of indocyanine green dye (ICG) has evolved significantly to the robotic operations including Robotic Assisted Radical Prostatectomy (RARP). The technology can help identification of sentinel lymphatic drainage in lymphadenectomy for majority of prostate cancer patients. We describe the potential indications of ICG for lymphadenectomy assistant in prostate cancer patients without lymph node or distant metastasis.

Methods:

We prospectively analyzed  prostate cancer patients without lymph node or distant metastasis with clinical pathological stage T1c to T3a received RARP from Nov 2019 to May 2020. The clinical data and pathological data including Gleason score, tumor volume, pathological stage and surgical findings were described. All lymph nodes was divided into ICG positive or negative. All patients was divided into low, moderate, and high risk according to EAU prostate cancer risk stratification.

Results:

Cystoscope guided intraprostatic injection was performed successively in Thirty-four localized prostate cancer patients in this study. The mean age was 66.1±7.8 years old. The patients number of high, moderate and low risk were 18,10,6. Total 447 lymph nodes were identified. 262 lymph nodes were ICG positive and 181 lymph nodes were ICG negative. ICG positive rate higher in high risk patients 158/259 (61.0%) compare to intermediate/low risk patients 104/188 (55.3%) There was no statistic significant result but lymph node could be identified in all ICG positive tissues. There were 12 patients revealed higher Gleason grade group after RARP and 2 patients revealed lower Gleason grade group after RARP. There were 18 patients showed upgrade stage after RARP and 4 patients showed down stage after RARP.

Conclusions:

Cystoscope guided intraprostatic ICG injection with fluorescence Lymphangiography can help identify pelvic lymph nodes in Robotic Assisted Radical Prostatectomy for Prostate Cancer Patients without lymph node or distant metastasis.