Touijer Karim, Rabbani Farhang, Otero Javier Romero, Secin Fernando P, Eastham James A, Scardino Peter T, Guillonneau Bertrand
Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Urol. 2007 Jul;178(1):120-4. doi: 10.1016/j.juro.2007.03.018. Epub 2007 May 11.
We determined the yield of standard vs limited pelvic lymphadenectomy in patients with a predicted risk of lymph node metastasis greater than 1% according to the Partin tables predicted probability of pathological stage. We also determined the feasibility of laparoscopic standard pelvic lymph node dissection.
Of 1,269 patients with clinically localized prostate cancer undergoing radical prostatectomy, 648 had a Partin's table predicted probability of lymph node invasion greater than 1%. Of the 648 patients 177 underwent limited pelvic lymph node dissection performed laparoscopically (group 1), and 471 underwent standard pelvic lymph node dissection performed open (367) or laparoscopically (104) (group 2). Templates of limited pelvic lymph node dissection included the external iliac lymph nodes whereas standard pelvic lymph node dissection included the external iliac, obturator and hypogastric lymph nodes. Multivariate logistic regression analyses were performed to compare the node positivity rate between groups 1 and 2.
On multivariate logistic regression analysis controlling for prostate specific antigen, biopsy Gleason sum, clinical stage and surgical approach, the odds of node positivity were 7.15-fold higher (95% CI 2.49-20.5, p<0.001) for standard vs limited pelvic lymph node dissection. The median (mean) number of nodes retrieved was 9 (10) and 14 (15) after limited and standard pelvic lymph node dissection, respectively (p<0.001). A similar impact was observed in patients treated laparoscopically with standard vs limited pelvic lymph node dissection (odds ratio 15.6, 95% CI 3.7-66.4, p<0.001).
Standard lymph node dissection yields positive nodes more frequently and retrieves a higher total nodal count than the often performed pelvic lymph node dissection limited to the external iliac nodes. Standard pelvic lymph node dissection is feasible through a transperitoneal laparoscopic approach.
根据Partin表预测的病理分期概率，我们确定了淋巴结转移预测风险大于1%的患者中标准盆腔淋巴结清扫术与有限盆腔淋巴结清扫术的检出率。我们还确定了腹腔镜标准盆腔淋巴结清扫术的可行性。
在1269例接受根治性前列腺切除术的临床局限性前列腺癌患者中，648例Partin表预测的淋巴结侵犯概率大于1%。在这648例患者中，177例行腹腔镜下有限盆腔淋巴结清扫术（第1组），471例行开放式（367例）或腹腔镜下（104例）标准盆腔淋巴结清扫术（第2组）。有限盆腔淋巴结清扫术的模板包括髂外淋巴结，而标准盆腔淋巴结清扫术包括髂外、闭孔和下腹淋巴结。进行多因素逻辑回归分析以比较第1组和第2组之间的淋巴结阳性率。
在对前列腺特异性抗原、活检Gleason评分、临床分期和手术方式进行多因素逻辑回归分析时，标准盆腔淋巴结清扫术与有限盆腔淋巴结清扫术相比，淋巴结阳性的几率高7.15倍（95%可信区间2.49-20.5，p<0.001）。有限和标准盆腔淋巴结清扫术后，回收淋巴结的中位数（平均数）分别为9（10）个和14（15）个（p<0.001）。在接受腹腔镜标准盆腔淋巴结清扫术与有限盆腔淋巴结清扫术治疗的患者中观察到类似的影响（优势比15.6，95%可信区间3.7-66.4，p<0.001）。
与通常进行的仅限于髂外淋巴结的盆腔淋巴结清扫术相比，标准淋巴结清扫术更常检出阳性淋巴结，且回收的淋巴结总数更高。经腹腹腔镜入路进行标准盆腔淋巴结清扫术是可行的。
