Extraperitoneal Laparoscopic Pelvic Lymph Node Dissection in the Staging of Prostate Carcinoma

Lee, Kyu Seung; Oh, Wook; Kim, Sang Jin; Chun, Seong Soo; Kim, Dae Kyung; Lee, Sung Won; Choi, Han Yong; Chai, Soo Eung

Abstract

PURPOSE
Diagnostic sampling of pelvic lymph nodes is generally accepted as the optimal procedure for evaluating the metastatic status of locally curable prostate carcinoma. It is usually done by open surgery, but recent developments in laparoscopic surgery have provided another option and are theoretically associated with less trauma and fewer complications than those reported from conventional surgery. We now report our experience, progression and complication of extraperitoneal laparoscopic pelvic lymph node dissection (LPLND).
MATERIALS AND METHODS
Between Dec. 1996 and Feb. 1998, 14 patients with high serum PSA (> or = 10 ng/ml) or high Gleason score (> or =5) underwent LPLND before radical perineal prostatectomy. The mean age of 14 patients was 64.46.5 years. The mean of serum PSA level was 51.4+/-39.3 ng/ml, and the mean Gleason score was 7.3+/-1.6. We used balloon dissector for the creation of extraperitoneal space, and perfonned LPLND with a CO2 insufflation through extraperitonium.
RESULTS
The average operation time was 138.2+/-29.8 minutes and estimated intraoperative bload loss was 80ml. The Jackson-Pratt drain was removed 3 days postoperatively and the mean drainage volume was 220.5+/-105.2 ml. The average number of dissected nodes was 7.6+/-4.4 (Rt.: 4.1+/-2.9, Lt.: 3.5+/-2.3), and LN metastasis was noted in 4 patients (28.6%). Complications included subcutaneous emphysema (7 patients), peritoneal laceration (3) and obturator nerve injury (1). The mean dissected LN number of the latter 9 cases was 8.6+/-4.8 compared with 6.0+/-3.3 of initial 5 cases, the mean operation time (minute) of the latter 9 cases was 132.8+/-26.6 compared with 148.0+/- 35.8 of initial 5 cases.
CONCLUSIONS
The laparoscopic approach can be performed within a resonable time limit and allows adequate assessment of the pelvic lymph node with minimal operative morbidity. Extraperitoneal LPLND is the minimally invasive procedure of choice for the evaluation of patients who are at increased risk of having metastatic pelvic lymph node involvement by prostate cancer.