Sunada Takuro, Kobayashi Takashi, Shibasaki Noboru, Okada Yoshiyuki, Negoro Hiromitsu, Terada Naoki, Yamasaki Toshinari, Matsui Yoshiyuki, Inoue Takahiro, Kamba Tomomi, Ogawa Osamu
The Department of Urology, Kyoto University Hospital.
Hinyokika Kiyo. 2015 Mar;61(3):89-93.
To evaluate the safety and adequacy of pelvic lymph node dissection (LND) in robot-assisted laparoscopic radical prostatectomy (RALP) in an institutional introductory case series, we retrospectively reviewed the first 135 patients with clinically localized prostate cancer who underwent RALP with no LND (n＝78), limited LND (LLND, n＝40), or extended LND (ELND, n＝17). Data were collected foroperating time itemized by each surgical procedure, estimated blood loss, lymph node yield, total postoperative drainage amount, postoperative days to drainage tube removal and urethral catheter removal, perioperative complication, and postoperative hospital stay. LLND and ELND took a median of 19 (interquartile range 15-22) and 69 (60.5-91) min, respectively. Total operating time was significantly longer (p＜0.0001) for those with ELND (median 329 min ; interquartile 272-375) than those with no LND (239 ; 195-292) and LLND (281 ; 230-314). Lymph node yield was 7 (5-9) and 23 (12-30) for LLND and ELND, respectively, which was equivalent to the yield of lymph nodes dissected in open prostatectomy ashistorical and institutional control. Although total drainage amount was significantly greater and drainage tube was placed significantly longer in the ELND group, there were no significant differences in time to urethral catheter removal and postoperative hospital stay among the groups. There were no severe perioperative complications associated with LND except for prolonged lymph fistula in each case of the LLND and ELND groups. In conclusion, LND can be performed safely and adequately in introductory RALP cases.
在一项机构性初步病例系列研究中，为评估机器人辅助腹腔镜根治性前列腺切除术（RALP）中盆腔淋巴结清扫术（LND）的安全性和充分性，我们回顾性分析了前135例临床局限性前列腺癌患者，这些患者接受了RALP手术，其中未行LND的患者78例、行有限淋巴结清扫术（LLND）的患者40例、行扩大淋巴结清扫术（ELND）的患者17例。收集的数据包括按每种手术步骤细分的手术时间、估计失血量、淋巴结获取数量、术后总引流量、术后引流管拔除天数和导尿管拔除天数、围手术期并发症以及术后住院时间。LLND和ELND的中位时间分别为19分钟（四分位间距15 - 22分钟）和69分钟（60.5 - 91分钟）。ELND患者的总手术时间（中位时间329分钟；四分位间距272 - 375分钟）显著长于未行LND的患者（239分钟；195 - 292分钟）和LLND患者（281分钟；2,30 - 314分钟）（p＜0.0001）。LLND和ELND的淋巴结获取数量分别为7个（5 - 9个）和23个（12 - 30个），这与开放性前列腺切除术中作为历史和机构对照的淋巴结获取数量相当。尽管ELND组的总引流量显著更多且引流管留置时间显著更长，但各组间导尿管拔除时间和术后住院时间并无显著差异。除LLND和ELND组各有1例出现长时间淋巴瘘外，未发现与LND相关的严重围手术期并发症。总之，在RALP初步病例中，LND可以安全、充分地进行。
