Van Praet Charles, Decaestecker Karel, Fonteyne Valérie, Ost Piet, De Visschere Pieter, Verschuere Stephanie, Rottey Sylvie, Lumen Nicolaas
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Int J Urol. 2014 Nov;21(11):1138-43. doi: 10.1111/iju.12534. Epub 2014 Jun 25.
To prospectively assess contemporary complication rates of minimally-invasive staging pelvic lymph node dissection before curative radiotherapy for prostate cancer using a standardized classification.
A total of 100 prostate cancer patients underwent laparoscopic or robot-assisted pelvic lymph node dissection (95% extended). Surgical outcomes were compared with those of 43 patients undergoing open pelvic lymph node dissection (33% extended). Complications were recorded prospectively during hospitalization and follow-up visits, and graded using Clavien-Dindo classification. Lymphocele size was measured on postoperative magnetic resonance imaging or computed tomography.
Of the complications recorded, 10% were grade 1, 3% were grade 2 and 6% were grade 3. No grade 4-5 complications occurred. Compared with open pelvic lymph node dissection, minimally-invasive pelvic lymph node dissection was associated with less blood loss (P = 0.001) and shorter hospital stay (median 3 vs 6 days; P < 0.001), but longer operation time (130 vs 98 min; P < 0.001). The complication rate was similar in both groups. For the entire cohort, overall and symptomatic lymphoceles were seen in 91 (64%) and 18 patients (13%), respectively. On multivariate logistic regression, minimally-invasive surgery was the only independent predictor for lymphocele development (odds ratio 3.99; P = 0.015).
Minimally-invasive extended pelvic lymph node dissection before curative radiotherapy is associated with low morbidity. Asymptomatic lymphocele development rate is higher compared with open pelvic lymph node dissection.
采用标准化分类法，前瞻性评估前列腺癌根治性放疗前微创分期盆腔淋巴结清扫术的当代并发症发生率。
共有100例前列腺癌患者接受了腹腔镜或机器人辅助盆腔淋巴结清扫术（95%为扩大清扫）。将手术结果与43例行开放性盆腔淋巴结清扫术（33%为扩大清扫）的患者进行比较。在住院期间和随访时前瞻性记录并发症，并使用Clavien-Dindo分类法进行分级。术后通过磁共振成像或计算机断层扫描测量淋巴囊肿大小。
在记录的并发症中，10%为1级，3%为2级，6%为3级。未发生4-5级并发症。与开放性盆腔淋巴结清扫术相比，微创盆腔淋巴结清扫术的失血量更少（P = 0.001），住院时间更短（中位时间3天对6天；P < 0.001），但手术时间更长（130分钟对98分钟；P < 0.001）。两组的并发症发生率相似。在整个队列中，分别有91例（64%）和18例（13%）出现了总体和有症状的淋巴囊肿。在多因素逻辑回归分析中，微创手术是淋巴囊肿形成的唯一独立预测因素（比值比3.99；P = 0.015）。
前列腺癌根治性放疗前的微创扩大盆腔淋巴结清扫术并发症发生率较低。与开放性盆腔淋巴结清扫术相比，无症状性淋巴囊肿的发生率更高。
