Department of Urology, Saint-Louis Hospital, APHP, Paris, France; Department of Urology, Jewish General Hospital and Montreal General Hospital, McGill University, Montreal, Canada; INSERM 955, Team 7, University Paris 12, Créteil, France.
Eur Urol. 2014 Jan;65(1):7-16. doi: 10.1016/j.eururo.2013.03.057. Epub 2013 Apr 6.
Pelvic lymph node dissection (PLND) in prostate cancer is the most effective method for detecting lymph node metastases. However, a decline in the rate of PLND during radical prostatectomy (RP) has been noted. This is likely the result of prostate cancer stage migration in the prostate-specific antigen-screening era, and the introduction of minimally invasive approaches such as robot-assisted radical prostatectomy (RARP).
To assess the efficacy, limitations, and complications of PLND during RARP.
A review of the literature was performed using the Medline, Scopus, and Web of Science databases with no restriction of language from January 1990 to December 2012. The literature search used the following terms: prostate cancer, radical prostatectomy, robot-assisted, and lymph node dissection.
The median value of nodal yield at PLND during RARP ranged from 3 to 24 nodes. As seen in open and laparoscopic RP series, the lymph node positivity rate increased with the extent of dissection during RARP. Overall, PLND-only related complications are rare. The most frequent complication after PLND is symptomatic pelvic lymphocele, with occurrence ranging from 0% to 8% of cases. The rate of PLND-associated grade 3-4 complications ranged from 0% to 5%. PLND is associated with increased operative time. Available data suggest equivalence of PLND between RARP and other surgical approaches in terms of nodal yield, node positivity, and intraoperative and postoperative complications.
PLND during RARP can be performed effectively and safely. The overall number of nodes removed, the likelihood of node positivity, and the types and rates of complications of PLND are similar to pure laparoscopic and open retropubic procedures.
前列腺癌盆腔淋巴结清扫术（PLND）是检测淋巴结转移的最有效方法。然而，根治性前列腺切除术（RP）中 PLND 的比例有所下降。这可能是前列腺特异性抗原筛查时代前列腺癌分期转移的结果，以及微创方法（如机器人辅助根治性前列腺切除术（RARP））的引入。
评估 RARP 中 PLND 的疗效、局限性和并发症。
使用 Medline、Scopus 和 Web of Science 数据库对文献进行了综述，无语言限制，检索时间为 1990 年 1 月至 2012 年 12 月。文献检索使用了以下术语：前列腺癌、根治性前列腺切除术、机器人辅助和淋巴结清扫。
RARP 中 PLND 的中位淋巴结检出数范围为 3 至 24 个。与开放和腹腔镜 RP 系列一样，随着 RARP 中淋巴结清扫范围的扩大，淋巴结阳性率也随之增加。总体而言，PLND 相关并发症很少见。PLND 后最常见的并发症是有症状的盆腔淋巴囊肿，发生率为 0%至 8%。PLND 相关 3-4 级并发症发生率为 0%至 5%。PLND 与手术时间延长有关。现有数据表明，在淋巴结检出数、淋巴结阳性率、术中及术后并发症方面，RARP 与其他手术方法的 PLND 相当。
RARP 中 PLND 可以安全有效地进行。PLND 切除的淋巴结总数、淋巴结阳性率以及并发症的类型和发生率与纯腹腔镜和开放经耻骨后入路手术相似。
