Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN 37232, USA.
Curr Urol Rep. 2011 Jun;12(3):203-8. doi: 10.1007/s11934-011-0179-z.
Pelvic lymph node dissection (PLND) represents the standard for detection of occult pelvic nodal metastases from prostate cancer, and may be performed separately from or at the time of radical prostatectomy. In addition to its potential for diagnostic staging, a PLND may be therapeutic in some patients. However, considerable debate centers on the appropriate candidates for the procedure, the extent and proper boundaries of dissection, optimal surgical approach, and absolute oncologic benefit. Several series suggest that there likely is limited benefit of PLND in low-risk patients and that PLND can be safely omitted in a high percentage of men undergoing contemporary radical prostatectomy. Furthermore, the value of PLND in patients with intermediate- and high-risk disease must be balanced against the potential morbidity of the procedure. In the setting of this debate, concern over morbidity directly attributable to this procedure is of paramount importance. This review focuses on the complications associated with PLND, including lymphocele, thromboembolic events, ureteral injury, nerve injury, vascular injury, and lymphedema.
盆腔淋巴结清扫术 (PLND) 是检测前列腺癌隐匿性盆腔淋巴结转移的标准方法，可以在根治性前列腺切除术之前或同时进行。除了具有诊断分期的潜力外，PLND 在某些患者中可能具有治疗作用。然而，对于该手术的合适患者、清扫的范围和适当界限、最佳手术方法以及确切的肿瘤学获益，存在着相当大的争议。有几项研究表明，PLND 对低危患者的获益可能有限，并且在接受当代根治性前列腺切除术的男性中，有很大比例可以安全地省略 PLND。此外，PLND 在中高危疾病患者中的价值必须与该手术的潜在发病率相平衡。在这种争议的背景下，对直接归因于该手术的发病率的关注至关重要。本文重点介绍了与 PLND 相关的并发症，包括淋巴囊肿、血栓栓塞事件、输尿管损伤、神经损伤、血管损伤和淋巴水肿。
