Puppo P, Perachino M, Ricciotti G, Carmignani G, Maffezzini M
Department of Urology, S. Corona Hospital, Pietra Ligure (SV), Italy.
Arch Ital Urol Androl. 1994 Jun;66(3):117-23.
Laparoscopic pelvic lymphadenectomy has been proposed for staging of prostate cancer and it might be used, in selected cases, also in bladder cancer. On a total of 31 laparoscopic lymphadenectomies (LPND), 18 for prostate cancer and 13 for bladder cancer, we found positive nodes in 8 cases (26.1%), 4 in prostate and 4 in bladder cancer group. We had no intraoperative complications and negligible postoperative complications (in 10% of cases shoulder-tip pain and in 24% subcutaneous emphysema); all these spontaneously disappeared after 24-36 hours. Patients with negative nodes underwent radical surgery except two prostate cancer patients who underwent radiotherapy, and patients with positive nodes underwent hormonal therapy (for prostate cancer) or chemoradiotherapy protocol (for bladder cancer). In conclusion, laparoscopic lymphadenectomy proved to be a feasible and safe method for staging urological malignancies, being less invasive, with shorter hospitalization and postoperative convalescence than open lymphadenectomy. It should be mainly indicated in high risk prostate cancer patients (elevated PSA and/or Gleason score). In bladder cancer patients, it could be proposed in bladder sparing investigational protocols, as the percentage of pelvic nodes metastases in T2/T3 bladder cancer is sufficiently high to justify an additional staging procedure.
腹腔镜盆腔淋巴结清扫术已被用于前列腺癌的分期，在某些特定情况下，也可用于膀胱癌。在总共31例腹腔镜淋巴结清扫术（LPND）中，18例用于前列腺癌，13例用于膀胱癌，我们发现8例（26.1%）有阳性淋巴结，前列腺癌组和膀胱癌组各4例。术中无并发症，术后并发症可忽略不计（10%的病例出现肩峰疼痛，24%出现皮下气肿）；所有这些并发症在24 - 36小时后均自行消失。淋巴结阴性的患者接受了根治性手术，但有两名前列腺癌患者接受了放疗，而淋巴结阳性的患者接受了激素治疗（用于前列腺癌）或放化疗方案（用于膀胱癌）。总之，腹腔镜淋巴结清扫术被证明是一种用于泌尿系统恶性肿瘤分期的可行且安全的方法，与开放淋巴结清扫术相比，其侵入性更小，住院时间和术后恢复时间更短。它主要适用于高危前列腺癌患者（PSA升高和/或Gleason评分升高）。在膀胱癌患者中，在保留膀胱的研究方案中可以考虑采用，因为T2/T3期膀胱癌盆腔淋巴结转移的比例足够高，足以证明需要额外进行分期手术。
