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Laparoscopic extended pelvic lymph node dissection for prostate cancer: description of the surgical technique and initial results.
Eur Urol. 2007 Nov; 52(5):1347-55.EU

Abstract

OBJECTIVE

In patients with prostate cancer, extended pelvic lymph node dissection (ePLND) yields a higher number of lymph node metastases (LNM) than standard pelvic lymph node dissection (PLND) of the obturator fossa only. We describe our laparoscopic technique of extended lymph node dissection and provide the number and locations of positive lymph nodes from our experience.

METHODS

In a total of 35 selected patients with clinically localized prostate cancer, laparoscopic ePLND was performed prior to laparoscopic radical prostatectomy. The template included the genitofemoral nerve up to the bifurcation of the common iliac artery and down to the epigastric artery. In the "split and roll" technique the internal and external iliac arteries including the bifurcation and the external iliac vein were completely mobilized. After freeing the obturator nerve, the entire lymph node package was released from the pelvic side wall.

RESULTS

Mean operative time was 90min/patient. The complications were two temporary and reversible neurapraxias (ischiatic nerve and obturator nerve), one deep vein thrombosis, and two lymphoceles. One lymphocele healed conservatively; the second was marsupialized laparoscopically. Eleven (31.4%) patients had lymph node metastases; their mean prostate-specific antigen (PSA) level was 20.3+/-7.0 ng/ml (range: 5.2-39.7 ng/ml) and their median Gleason sum in biopsy was 7 (range: 6-8). Mean size of the LNM was 3.1+/-1.0 mm (range: 0.2-8). In 5 of the 11 patients with LNM these were detected exclusively outside the obturator fossa. LNM were in the obturator fossa only in two (one bilateral), around the external iliac artery only in two, around the internal iliac artery only in two, and around the external iliac artery and internal iliac only in one patient.

CONCLUSIONS

Laparoscopic ePLND can be combined with laparoscopic radical prostatectomy. Standardization of the technique facilitates surgery to a great extent. e-PLND detects LNM in a significant number of patients. The majority of LNM are outside the obturator fossa. The transperitoneal approach allows a wide exposure and is the most important factor to enable successful ePLND.

Authors+Show Affiliations

Department of Urology, Krankenhaus der Elisabethinen, Linz, Austria.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17507150

Citation

Lattouf, Jean-Baptiste, et al. "Laparoscopic Extended Pelvic Lymph Node Dissection for Prostate Cancer: Description of the Surgical Technique and Initial Results." European Urology, vol. 52, no. 5, 2007, pp. 1347-55.
Lattouf JB, Beri A, Jeschke S, et al. Laparoscopic extended pelvic lymph node dissection for prostate cancer: description of the surgical technique and initial results. Eur Urol. 2007;52(5):1347-55.
Lattouf, J. B., Beri, A., Jeschke, S., Sega, W., Leeb, K., & Janetschek, G. (2007). Laparoscopic extended pelvic lymph node dissection for prostate cancer: description of the surgical technique and initial results. European Urology, 52(5), 1347-55.
Lattouf JB, et al. Laparoscopic Extended Pelvic Lymph Node Dissection for Prostate Cancer: Description of the Surgical Technique and Initial Results. Eur Urol. 2007;52(5):1347-55. PubMed PMID: 17507150.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic extended pelvic lymph node dissection for prostate cancer: description of the surgical technique and initial results. AU - Lattouf,Jean-Baptiste, AU - Beri,Avi, AU - Jeschke,Stephan, AU - Sega,Wolfgang, AU - Leeb,Karl, AU - Janetschek,Günter, Y1 - 2007/05/02/ PY - 2007/01/11/received PY - 2007/04/24/accepted PY - 2007/5/18/pubmed PY - 2008/1/16/medline PY - 2007/5/18/entrez SP - 1347 EP - 55 JF - European urology JO - Eur Urol VL - 52 IS - 5 N2 - OBJECTIVE: In patients with prostate cancer, extended pelvic lymph node dissection (ePLND) yields a higher number of lymph node metastases (LNM) than standard pelvic lymph node dissection (PLND) of the obturator fossa only. We describe our laparoscopic technique of extended lymph node dissection and provide the number and locations of positive lymph nodes from our experience. METHODS: In a total of 35 selected patients with clinically localized prostate cancer, laparoscopic ePLND was performed prior to laparoscopic radical prostatectomy. The template included the genitofemoral nerve up to the bifurcation of the common iliac artery and down to the epigastric artery. In the "split and roll" technique the internal and external iliac arteries including the bifurcation and the external iliac vein were completely mobilized. After freeing the obturator nerve, the entire lymph node package was released from the pelvic side wall. RESULTS: Mean operative time was 90min/patient. The complications were two temporary and reversible neurapraxias (ischiatic nerve and obturator nerve), one deep vein thrombosis, and two lymphoceles. One lymphocele healed conservatively; the second was marsupialized laparoscopically. Eleven (31.4%) patients had lymph node metastases; their mean prostate-specific antigen (PSA) level was 20.3+/-7.0 ng/ml (range: 5.2-39.7 ng/ml) and their median Gleason sum in biopsy was 7 (range: 6-8). Mean size of the LNM was 3.1+/-1.0 mm (range: 0.2-8). In 5 of the 11 patients with LNM these were detected exclusively outside the obturator fossa. LNM were in the obturator fossa only in two (one bilateral), around the external iliac artery only in two, around the internal iliac artery only in two, and around the external iliac artery and internal iliac only in one patient. CONCLUSIONS: Laparoscopic ePLND can be combined with laparoscopic radical prostatectomy. Standardization of the technique facilitates surgery to a great extent. e-PLND detects LNM in a significant number of patients. The majority of LNM are outside the obturator fossa. The transperitoneal approach allows a wide exposure and is the most important factor to enable successful ePLND. SN - 0302-2838 UR - https://www.unboundmedicine.com/medline/citation/17507150/Laparoscopic_extended_pelvic_lymph_node_dissection_for_prostate_cancer:_description_of_the_surgical_technique_and_initial_results_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(07)00665-3 DB - PRIME DP - Unbound Medicine ER -