Finelli Antonio
Department of Surgical Oncology (Urology), University Health Network, University of Toronto, Toronto, Ontario, Canada.
Curr Opin Urol. 2008 Mar;18(2):180-4. doi: 10.1097/MOU.0b013e3282f4a880.
Laparoscopic retroperitoneal lymph node dissection was first described in 1992, and has become more commonly practiced at certain centers. Laparoscopic retroperitoneal lymph node dissection may be less morbid than open retroperitoneal lymph node dissection, but more costly. Controversy exists, however, regarding the oncologic adequacy of the procedure. The published literature regarding the oncologic outcomes of laparoscopic retroperitoneal lymph node dissection is reviewed herein.
Laparoscopic retroperitoneal lymph node dissection has not been as widely adopted as other laparoscopic procedures for genitourinary malignancy. There have only been seven publications in the last 3 years, often coming from the same centers. Recently there has been a change in practice with a greater effort to perform therapeutic laparoscopic retroperitoneal lymph node dissection and not simply a staging procedure. Adjuvant chemotherapy is no longer routinely offered to all patients with positive nodes.
The impressive cure rate and decreasing morbidity associated with conventional open retroperitoneal lymph node dissection are difficult to improve upon. While on par with open retroperitoneal lymph node dissection series, the current oncologic outcomes are difficult to attribute to successful laparoscopic retroperitoneal lymph node dissection alone. Most patients with viable tumor in the retroperitoneal lymph node dissection specimen received chemotherapy. Thus, we must await follow-up of the patients who declined adjuvant chemotherapy after laparoscopic retroperitoneal lymph node dissection or the results of more recent initiatives with laparoscopic retroperitoneal lymph node dissection alone.
腹腔镜腹膜后淋巴结清扫术于1992年首次被描述，在某些中心已更普遍地开展。腹腔镜腹膜后淋巴结清扫术可能比开放性腹膜后淋巴结清扫术的创伤小，但费用更高。然而，关于该手术的肿瘤学充分性仍存在争议。本文对已发表的关于腹腔镜腹膜后淋巴结清扫术肿瘤学结局的文献进行综述。
腹腔镜腹膜后淋巴结清扫术尚未像其他用于泌尿生殖系统恶性肿瘤的腹腔镜手术那样被广泛采用。在过去3年中仅有7篇相关文献发表，且常常来自相同的中心。近来，实践中出现了一种变化，即更努力地进行治疗性腹腔镜腹膜后淋巴结清扫术，而不仅仅是分期手术。不再常规对所有淋巴结阳性患者提供辅助化疗。
传统开放性腹膜后淋巴结清扫术令人印象深刻的治愈率和不断降低的发病率很难被超越。虽然与开放性腹膜后淋巴结清扫术系列相当，但目前的肿瘤学结局很难仅归因于成功实施了腹腔镜腹膜后淋巴结清扫术。大多数在腹膜后淋巴结清扫标本中发现有存活肿瘤的患者接受了化疗。因此，我们必须等待对那些在腹腔镜腹膜后淋巴结清扫术后拒绝辅助化疗的患者进行随访，或者等待仅采用腹腔镜腹膜后淋巴结清扫术的最新研究结果。
