Analysis of feasibility of laparoscopic ilio-obturatory lymphadenectomy as a diagnostic method for prostate cancer staging
Article published in Urologia Polska 2002/55/4.

authors

Piotr Marczyński: Klinika Nowotworów Układu Moczowego Centrum Onkologii - Instytut im. M. Skłodowskiej-Curie w Warszawie Kierownik kliniki: doc. dr hab. Tomasz Demkow

keywords

prostate, prostate cancer, laparoscopy, lymphadenectomy

summary

Introduction. Patients with prostate cancer are feasible to radical treatment only when tumor is organ confined. Intraoperative histological examination of regional lymph nodes is a routine procedure proceeding retroperitoneal radical prostatectomy. Laparoscopic lymphadenectomy enables histological examination of regional lymph nodes before radical teleradiothcrapy.

Objectives.

1. Analysis of feasibility of laparoscope ifloobturatory lymphadcnecto-my as a diagnostic method for involvement of regional lymph nodes in patients with prostate cancer, qualified to radical radiotherapy.

2. Analysis of feasibility of Patentblau V dye injection to the prostate.

3. Analysis of probability of regional lymph nodes involvement in correlation with scrum PSA level, PSA density, T category and histological grade in Mostofi and Glascason scale.

4. Selection of a group of patients, for which laparoscopic lympha-denectomy is necessary due to high probability of metastases in regional lymph nodes.

Material and method. Laparoscopic ilio-obturatory lymphadenec-tomy before radical teleradiotherapy was performed in 60 patients. In a subgroup of first 17 patients Patentblau V was used as an attempt of sentinel lymph node dyeing.

Results of sentinel lymph node dyeing were analyzed. Statistical analysis of lymph nodes metastases was performed in correlation with: histological grading according to Mostofi and Gle-ason scores, PSA, PSAD and T category.

Results. In the group of 60 patients, metastases in regional lymph

nodes were found in 9 cases. Patentblau V injection to the prostate occurred not effective as a method of sentinel lymph node dyeing. Statistically significant decrease of the operating time was observed in the consecutive lymphadencctomies. Statistically significant correlation between serum PSA level and presence of metastases in regional lymph nodes was observed. Conclusions.

1. Laparoscopic ilio-obturatory lymphadenectomy is an effective method of lymph nodes resection for histological examination, with 98% success rate.

2. Laparoscopic ilio-obturatory lymphadenectomy is a safe procedure.

3. Patentblau V injection to the prostate is not effective as a method of sentinel lymph node dyeing.

4. Statistically significant correlation between serum PSA level and presence of metastases in regional lymph nodes was observed.

5. Laparoscopic verification of regional lymph nodes before radical radiotherapy is indicated in patients with serum PSA level (40 ng/ml). In patients with serum PSA level <40ng/ml probability of regional lymph nodes involvement is low and histological verification of regional lymph nodes can be omitted.

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