Liedberg Fredrik, Kjölhede Henrik, Sundqvist Pernilla
Fredrik Liedberg Department of Urology SUS, Malmö and Henrik Kjölhede and Pernilla Sundqvist Department Urology Växjö Country Hospital, Växjö, Sweden.
Scand J Urol Nephrol. 2012 Oct;46(5):332-6. doi: 10.3109/00365599.2012.681062. Epub 2012 May 8.
Assessing lymph-node status in prostate cancer patients with high accuracy is only possible with surgical staging, despite the evolution of modern imaging techniques. The use of surgical staging has to be balanced against the complications of the procedure, the individual patient's risk for harbouring metastases and the consequences for the treatment of the patient if such metastases are present. The aim of this study was to investigate complications at 90 days using a standardized method (Clavien) in a consecutive series of patients submitted to laparoscopic extended pelvic lymphadenectomy.
This population-based study included 133 high-risk prostate cancer patients scheduled for external beam radiation. Laparoscopic extended pelvic lymphadenectomy and registration of complications were performed in a standardized fashion. Complications were registered on a five-grade scale, and differences between groups were compared with the chi-squared test.
The mean hospital stay was 1.3 days. Only three patients (2%) suffered from grade 3 complications after surgery, whereas 35 patients (26%) had grade 1 complications and another 11 patients (8%) were treated for grade 2 complications. Of all patients, 35% had lymph-node metastasis, of whom 50% received intensified oncological treatment including adjuvant androgen deprivation and regional lymph-node radiation. Thus, 65% of the patients could be spared regional lymph-node radiation and its associated long-term toxicity.
Laparoscopic extended pelvic lymphadenectomy can be performed with minimal significant complications and short hospital stay in patients with high-risk prostate cancer.
尽管现代成像技术不断发展，但只有通过手术分期才能高精度地评估前列腺癌患者的淋巴结状态。手术分期的应用必须在手术并发症、个体患者发生转移的风险以及如果存在转移对患者治疗的影响之间进行权衡。本研究的目的是使用标准化方法（Clavien）对一系列接受腹腔镜扩大盆腔淋巴结清扫术的患者在90天时的并发症进行调查。
这项基于人群的研究纳入了133例计划接受外照射放疗的高危前列腺癌患者。以标准化方式进行腹腔镜扩大盆腔淋巴结清扫术并记录并发症。并发症按五级标准记录，组间差异采用卡方检验进行比较。
平均住院时间为1.3天。术后只有3例患者（2%）发生3级并发症，而35例患者（26%）发生1级并发症，另有11例患者（8%）接受了2级并发症的治疗。所有患者中，35%有淋巴结转移，其中50%接受了强化肿瘤治疗，包括辅助雄激素剥夺和区域淋巴结放疗。因此，65%的患者可以避免区域淋巴结放疗及其相关的长期毒性。
对于高危前列腺癌患者，腹腔镜扩大盆腔淋巴结清扫术可以在并发症极少且住院时间短的情况下进行。
