Hatzichristodoulou Georgios, Wagenpfeil Stefan, Wagenpfeil Gudrun, Maurer Tobias, Horn Thomas, Herkommer Kathleen, Hegemann Marie, Gschwend Jürgen E, Kübler Hubert
Department of Urology, Technical University of Munich, University Hospital Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital, Homburg/Saar, Germany.
World J Urol. 2016 Jun;34(6):811-20. doi: 10.1007/s00345-015-1699-9. Epub 2015 Sep 29.
To assess continence and erectile function (EF) recovery of extended pelvic lymph node dissection (ePLND) versus limited PLND (lPLND) after bilateral nerve-sparing radical prostatectomy (BNSRP).
Consecutive prostate cancer (PCa) patients undergoing BNSRP were stratified according to D'Amico into two groups: low-risk-PCa lPLND (obturator) and intermediate-/high-risk-PCa ePLND (obturator, external iliac artery, internal iliac artery, common iliac artery). Continence (no pad/one safety pad) and EF (IIEF-5 ≥ 17) recovery were assessed. Patients with phosphodiesterase type 5 inhibitors, neoadjuvant/adjuvant therapy, positive lymph nodes or positive surgical margins were excluded.
From January 2007 to May 2012, a total 966 consecutive patients were included. Four hundred and sixty patients met the inclusion/exclusion criteria: 262 patients had ePLND and 198 patients had lPLND. Mean number of lymph nodes was 20.4 (range 10-65) and 4.7 (range 0-10), respectively (p < 0.001). Continence and spontaneous EF recovery after 12 months were 89.7 versus 93.4 % and 40.4 versus 47.5 %, respectively (all p > 0.05). Patient age at surgery (p = 0.001), preoperative EF (p < 0.001) and pathological tumor stage (p = 0.008), but not ePLND (p = 0.561), were independent predictors of EF recovery. No association was detected for continence recovery. Seven-year BCR-free survival for pT2 PCa was 100 and 94.8 % in lPLND and ePLND, respectively (p = 0.011). For pT3 PCa, this was 94.7 and 81.2 %, respectively (p = 0.287). At 2 years, the trifecta of continence, potency and recurrence freedom was achieved in 47.5 and 44.1 % in lPLND and ePLND, respectively (p = 0.451).
ePLND is not associated with increased risk of postoperative incontinence or erectile dysfunction. Only patient age at surgery, preoperative EF and pathological tumor stage represent predictors of EF recovery.
评估双侧保留神经根治性前列腺切除术（BNSRP）后扩大盆腔淋巴结清扫术（ePLND）与局限性盆腔淋巴结清扫术（lPLND）的控尿和勃起功能（EF）恢复情况。
将接受BNSRP的连续性前列腺癌（PCa）患者根据达米科标准分为两组：低风险PCa行lPLND（闭孔）和中/高风险PCa行ePLND（闭孔、髂外动脉、髂内动脉、髂总动脉）。评估控尿（无尿垫/一个安全尿垫）和EF（国际勃起功能指数-5≥17）恢复情况。排除使用5型磷酸二酯酶抑制剂、新辅助/辅助治疗、淋巴结阳性或手术切缘阳性的患者。
2007年1月至2012年5月，共纳入966例连续性患者。460例患者符合纳入/排除标准：262例行ePLND，198例行lPLND。平均淋巴结数量分别为20.4个（范围10 - 65个）和4.7个（范围为0 - 10个）（p < 0.001）。12个月后的控尿和自发EF恢复率分别为89.7%对93.4%和40.4%对47.5%（所有p > 0.05）。手术时患者年龄（p = 0.001）、术前EF（p < 0.001）和病理肿瘤分期（p = 0.008）是EF恢复的独立预测因素，而ePLND不是（p = 0.561）。未检测到与控尿恢复的关联。pT2期PCa在lPLND和ePLND中的7年无生化复发生存率分别为100%和94.8%（p = 0.011）。对于pT3期PCa，分别为94.7%和81.2%（p = 0.287）。2年时，lPLND和ePLND中实现控尿、性功能和无复发三联成功的比例分别为47.5%和44.1%（p = 0.451）。
ePLND与术后尿失禁或勃起功能障碍风险增加无关。仅手术时患者年龄、术前EF和病理肿瘤分期是EF恢复的预测因素。
