Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
Department of Urology, Caritas St. Josef Medical Center, University Regensburg, Landshuter Strasse 64, 93053, Regensburg, Germany.
World J Urol. 2018 Jun;36(6):855-861. doi: 10.1007/s00345-018-2195-9. Epub 2018 Feb 9.
Pelvic lymph node dissection (PLND) is recommended for patients with prostate cancer (PCa) and significant risk for nodal metastases. This study aimed to assess guideline adherence regarding PLND according to the German S3 guideline as example for a national but highly used guideline on prostate cancer and to compare the rate of complications different approaches for radical prostatectomy (RP).
Patients undergoing open (RRP), laparoscopic (LARP) or robot-assisted (RARP) RP in six centers in Germany and Austria were included. The primary endpoint was the total number of removed lymph nodes (LN) between the different surgical approaches according to recent guideline recommendations. Secondary endpoints were the number of patients undergoing a sufficient PLND, defined as a removal of at least 10 LN and associated complication rates.
2634 patients undergoing RP were included (RRP: 66%, RARP/LARP: 34%). PLND was performed in 88% (RRP: 88.5%, RARP/LARP: 86.8%, p = 0.208). In intermediateor high risk PCa, PLND was performed in 97.2% (RRP: 97.7%, RARP/LARP: 96.2, p = 0.048). Of those, the mean number of LN was 19 (RRP: 19 vs. RARP/LARP: 17, p < 0.005) and sufficient PLND was observed in 84.6% of RRP compared to 77.2% of RARP/LARP (p < 0.005). Symptomatic lymphoceles requiring surgical treatment occurred more often in RRP than in RARP/LARP (4.0% vs. 1.6%, p = 0.001).
The general guideline adherence regarding performing PNLD and the LN yield is high, regardless of the surgical approach. As expected, lymph node yield was higher when very experienced surgeons conducted the procedure. This should be considered in patients' counseling.
盆腔淋巴结清扫术（PLND）推荐用于前列腺癌（PCa）患者和有淋巴结转移高风险的患者。本研究旨在评估德国 S3 指南中规定的 PLND 指南遵循情况，该指南是前列腺癌的国家指南，但应用非常广泛，并比较不同根治性前列腺切除术（RP）方法的并发症发生率。
纳入德国和奥地利 6 个中心接受开放（RRP）、腹腔镜（LARP）或机器人辅助（RARP）RP 的患者。主要终点是根据最新指南建议，不同手术方法之间切除的淋巴结总数（LN）。次要终点是接受充分 PLND 的患者数量，定义为至少切除 10 个 LN，并评估相关并发症发生率。
共纳入 2634 例接受 RP 的患者（RRP：66%，RARP/LARP：34%）。88%（RRP：88.5%，RARP/LARP：86.8%，p=0.208）的患者接受了 PLND。中高危 PCa 患者中，97.2%（RRP：97.7%，RARP/LARP：96.2%，p=0.048）接受了 PLND。其中，LN 的平均数量为 19（RRP：19 vs. RARP/LARP：17，p<0.005），RRP 中 84.6%的患者接受了充分的 PLND，而 RARP/LARP 中只有 77.2%（p<0.005）。需要手术治疗的症状性淋巴囊肿在 RRP 中比在 RARP/LARP 中更常见（4.0% vs. 1.6%，p=0.001）。
无论手术方式如何，进行 PLND 和 LN 检测的总体指南遵循情况都很高。正如预期的那样，当经验非常丰富的外科医生进行手术时，淋巴结的检出量更高。这在患者咨询时需要考虑。
