Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
Eur Urol. 2020 Sep;78(3):424-431. doi: 10.1016/j.eururo.2020.03.032. Epub 2020 Apr 20.
Extended pelvic lymph node dissection (ePLND) remains the most accurate procedure for lymph node staging in intermediate- and high-risk prostate cancer (PCa) patients undergoing radical prostatectomy (RP). A superextended pelvic lymph node dissection (sePLND) can be considered in selected very-high-risk PCa patients.
To demonstrate a reproducible robot-assisted technique for sePLND at the time of RP for PCa.
DESIGN, SETTING, AND PARTICIPANTS: From June 2016 to August 2019, 41 consecutive patients with localized PCa and very high risk for lymph node invasion (LNI) received a robot-assisted RP and a standardized 10-step monoblock ePLND, followed by a 5-step monoblock sePLND. Very high risk for LNI was defined as ≥30% risk for LNI, as calculated by the Briganti 2017 nomogram.
After performing the ePLND template resection (harvesting lymph nodes from the obturator region, external and internal iliac vessels, and common iliac vessels up to the ureter crossing), the 5-step monoblock sePLND approach was performed. The sePLND template was tailored to the common iliac vessels up to the aortic and caval bifurcation as well as the presacral region.
Lymph node yield, perioperative complications.
Overall, 41 patients received sePLND, reporting a median (interquartile range [IQR]) number of nodes removed of 23 (19-29). Median operative time (including RP, ePLND, and sePLND) was 256 min. Median preoperative prostate-specific antigen was 12 ng/mL (IQR 6.45-17.6). Disease stage pT <3 was found in 10 (24.4%) patients, pT3a in nine (22%) patients, pT3b in 21 (51.2%) patients, and pT4 in one (2.4%) patient. Of the treated patients, 54% revealed LNI: five (4.9%) in a solitary node, five (4.9%) in two to five nodes, and 12 (29.3%) in more than five nodes. Considering perioperative complications, three (7.3%) patients experienced Clavien I-II and four (9.7%) experienced Clavien ≥ III complications. Median hospital stay was 6 d. No patient underwent postoperative blood transfusion.
The 5-step sePLND approach is a reproducible and feasible technique for PCa patients at a very high risk of LNI.
In our study, we aimed to provide surgeons with a step-by-step technique for lymph node dissection, which aims to collect possibly metastatic lymph nodes of prostate cancer in an even more extended version ("superextended") than a standard ("extended") lymph node dissection.
在接受根治性前列腺切除术 (RP) 的中高危前列腺癌 (PCa) 患者中，扩大盆腔淋巴结清扫术 (ePLND) 仍然是淋巴结分期最准确的方法。在选择的极高危 PCa 患者中，可以考虑进行超广泛盆腔淋巴结清扫术 (sePLND)。
展示一种在 RP 时用于 PCa 的可重复的机器人辅助 sePLND 技术。
设计、设置和参与者：2016 年 6 月至 2019 年 8 月，41 例局部 PCa 且淋巴结侵犯 (LNI) 风险极高的患者接受了机器人辅助 RP 和标准化的 10 步整块 ePLND，随后进行了 5 步整块 sePLND。LNI 的极高风险定义为 Briganti 2017 列线图计算的 LNI 风险≥30%。
在完成 ePLND 模板切除（从闭孔区、外髂血管、内髂血管和髂总血管采集到输尿管交叉处的淋巴结）后，进行 5 步整块 sePLND 方法。sePLND 模板根据髂总血管裁剪，直至主动脉和腔静脉分叉以及骶前区域。
淋巴结产量，围手术期并发症。
总体而言，41 例患者接受了 sePLND，报告的平均（四分位距 [IQR]）切除淋巴结数为 23（19-29）个。中位手术时间（包括 RP、ePLND 和 sePLND）为 256 分钟。中位术前前列腺特异性抗原为 12ng/mL（IQR 6.45-17.6）。10 例（24.4%）患者疾病分期为 pT<3，9 例（22%）为 pT3a，21 例（51.2%）为 pT3b，1 例（2.4%）为 pT4。治疗患者中，54%有 LNI：5 例（4.9%）为单个淋巴结，5 例（4.9%）为 2-5 个淋巴结，12 例（29.3%）为>5 个淋巴结。考虑围手术期并发症，3 例（7.3%）患者发生 Clavien I-II 级并发症，4 例（9.7%）患者发生 Clavien≥III 级并发症。中位住院时间为 6 天。无患者术后输血。
5 步 sePLND 方法是一种可重复的技术，适用于 LNI 风险极高的 PCa 患者。
在我们的研究中，我们的目的是为外科医生提供一种淋巴结清扫的分步技术，旨在以比标准（“扩展”）淋巴结清扫更广泛的版本（“超扩展”）收集前列腺癌可能转移的淋巴结。
