以經腹膜外路徑執行機械手臂輔助攝護腺根除併完整淋巴廓清手術
在非低危險攝護腺癌的患者上的角色與預後
吳振宇1、林嘉祥1,2
1. 義大醫院 泌尿科; 2. 義守大學醫學院醫學系
The Role and Outcomes of Adequate Pelvic Lymph Node Dissection in Robotic-assisted Laparoscopic Radical Prostatectomy via Extraperitoneal Route for Non-low-risk Prostate Cancer
Richard C. Wu1, Victor C. Lin1,2
1. Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
2. School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
Purpose: Pelvic lymph node dissection (PLND) during radical prostatectomy potentially generates diagnostic and therapeutic benefits. Adequate dissection is essential to provide the benefits and the debate of the feasibility of performing robotic assisted laparoscopic radical prostatectomy (RARP) via extraperitoneal route remains limited evidence. We evaluated the outcomes in the outcomes for patient underwent this treatment modality.
Materials and Methods: We retrospectively review patient diagnosed with localized and reginal prostate cancer who underwent RARP and standard PLND (including external and internal iliac, peri-prostate and obturator nodes) between May 2016 and February 2020 at our institution. NCCN low-risk disease was excluded due to the PLND strategy is different from other risk stratification. The primary outcome is to evaluate the adequateness of PLND which is represented by the lymph node yield (LNY) and involved percentage (LNI). We also collected and analyzed the perioperative outcomes including complications.
Results: There are total 114 prostate cancer patients underwent RARP and PLND; 54 patients had intermediate-risk and 32 had high-risk disease while other 9 patient were reginal prostate cancer. The mean age and PSA of this two group was 68 and 10.2 ng/ml, 71 and 27.3 ng/ml, and 66 and 36.1 ng/ml in intermediate-risk, high-risk, and reginal group, respectively. Higher LNY was noted in reginal disease with mean 37.0 (range 17 – 76) nodes while there was 24.1 (5 – 67), and 27.0 (8 – 60) nodes in intermediate- and high-risk group respectively. The LNI was lower in intermediate-risk group (0.2%) than in high-risk (8.1%) and reginal group (6.6%). There were 3 (5.5%), 10 (31.2%), and 5 (55.6%) patients had pathologic nodal disease in intermediate-, high-risk, and reginal group. The overall lymphocele incidence was 4.2% and none of them required open surgical intervention.
Conclusion: PLND is technically feasible via extraperitoneal route when performing RARP. Remarkable nodal disease raises the concern of adequate PLND for providing accurate diagnosis, especially in high-risk and reginal disease. Although no open surgery was required in this study regarding lymphocele, the risk of this complication should be evaluated when performing RARP via extraperitoneal route.