針對中高風險局部攝護腺癌進行達文西根除性攝護腺切除

合併腹膜外擴大骨盆腔淋巴結廓清手術是否合適？

洪紹綸¹、吳振宇^1、2、吳俊賢¹、林嘉祥^1、2

¹義大醫療財團法人義大醫院 泌尿科；

²義守大學 醫學系

Is Extraperitoneal Extended Pelvic Lymph Node Dissection Adequate during

Robotic Assisted Radical Prostatectomy for Intermediate and High Risk Localized Prostate Cancer?

Leo Shao-Lun Hung¹, Richard Chen Yu Wu^1,2, Chun-Hsien Wu¹, Victor C. Lin^1,2

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Purpose: Extended pelvic lymph node dissection (EPLND) during robotic-assisted radical prostatectomy (RARP) for patients with high risk of lymph node metastasis is recommended in the robotic surgery era. The majority of RARP as well as EPLND are performed via transperitoneal route due to its easier approach and wider operative fields. Since extraperitoneal route approach has less reported, this study evaluated perioperative outcomes and complications among patients with localized prostate cancer who underwent extraperitoneal RARP with EPLND. 

Materials and Methods: Fifty-three patients with intermediate to high risk localized prostate cancer receiving extraperitoneal RARP with EPLND by a single surgeon were included in this study between 2016 and 2021. Perioperative complications, length of hospital stay, surgical margin involvement, lymph nodes metastases and lymph node yields were collected retrospectively.

Results: The median patient age was 69 years old (range 50-81). Eighteen patients (34%) were intermediate risk while the other 35 patients were high risk (66%). Median time to oral intake was on the post-operative day 1 (range:1-3) and median hospital stay was 9 days (range:5-17). The median lymph node yield was 30 (range:13-76) and 17 patients (32.1%) were confirmed lymph nodes metastasized. Twenty-three patients (43.4%) were found to have surgical margins involved. Five patients (9.4%) developed Clavien-Dindo Grade III complications and all of them were diagnosed lymphocele and well recovered after image-guided drainage and antibiotic treatment. Thirty-nine patients (73.6%) had time to prostate-specific antigen (PSA) nadir within 3 months post-operatively.      

Conclusions: Extraperitoneal approach EPLND might be anatomically feasible during RARP with adequate lymph node yield. Post-operative lymphocele could be well treated by drainage and antibiotic treatment.