Ozkan Burak, Tunc Burcin, Coskuner Enis Rauf, Saglican Yesim, Yalçın Veli
Department of Urology, Faculty of Medicine, Acibadem Bakirkoy and Maslak Hospitals, Acibadem University, Halit Ziya Usakligil Cad. No: 1, 34140, Bakirkoy, Istanbul, Turkey,
Int Urol Nephrol. 2015 Jun;47(6):959-64. doi: 10.1007/s11255-015-0982-4. Epub 2015 Apr 22.
To determine the incidence and significance of lymph nodes found in anterior prostatic fat pad (APFP) and to evaluate the risk factors for the lymph node presence at the APFP according to preoperative and postoperative characteristics during the robot-assisted radical prostatectomy (RARP).
Between January 2011 and December 2014, 100 consecutive patients (47-77) with clinically localized prostate cancer underwent APFP excision during RARP at a single institute. Extended pelvic lymph node dissection was also performed to moderate- and high-risk patients (86 patients). Preoperative and postoperative findings were recorded, and descriptive analyses and multivariable analyses to predict the presence of lymph node within APFP were performed.
Lymph nodes within APFP were detected in nine (9 %) patients. None of the patients had metastatic lymph node in APFP. Preoperatively, mean PSA levels (14.22 vs. 8.6, p = 0.0001), biopsy Gleason score (p = 0.002) and radical prostatectomy pathology Gleason score (p = 0.001) were higher in patients with lymph nodes at the APFP tissue. Pelvic lymph node metastases were detected in seven of 86 (8 %) patients. Of these seven patients, four (57 %) had lymph nodes at the anterior prostatic fatty pad (p = 0.0001).
APFP dissection must be done regardless of the radical prostatectomy technique chosen. In our opinion, it is not necessary to do pathological examination of the APFP tissue routinely except for the patients with high preoperative PSA values, patients with high prostate biopsy Gleason scores and patients at high risk in order to save time and cost.
确定前列腺前脂肪垫（APFP）中发现的淋巴结的发生率及意义，并根据机器人辅助根治性前列腺切除术（RARP）术前和术后特征评估APFP处存在淋巴结的危险因素。
2011年1月至2014年12月，100例年龄在47 - 77岁之间、临床局限性前列腺癌患者在单一机构接受RARP手术时行APFP切除。中高危患者（86例）还进行了扩大盆腔淋巴结清扫。记录术前和术后结果，并进行描述性分析和多变量分析以预测APFP内淋巴结的存在情况。
9例（9%）患者在APFP中检测到淋巴结。所有患者的APFP中均未发现转移性淋巴结。术前，APFP组织中有淋巴结的患者平均前列腺特异性抗原（PSA）水平（14.22对8.6，p = 0.0001）、活检Gleason评分（p = 0.002）和根治性前列腺切除术病理Gleason评分（p = 0.001）更高。86例患者中有7例（8%）检测到盆腔淋巴结转移。在这7例患者中，4例（57%）在前列腺前脂肪垫有淋巴结（p = 0.0001）。
无论选择何种根治性前列腺切除术技术，均必须进行APFP清扫。我们认为，为节省时间和成本，除术前PSA值高、前列腺活检Gleason评分高及高危患者外，无需常规对APFP组织进行病理检查。
