Results of laparoscopic pelvic lymphadenectomy in patients at high risk for nodal metastases from prostate cancer

Bruce Kava, Guido Dalbagni, Kevin C. Conlon, Paul Russo

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Laparoscopic pelvic lymphadenectomy (LPLND) can be performed safely and with minimal morbidity in the staging of prostate cancer. Its utility in evaluating patients at high risk for metastatic disease before primarily nonsurgical treatment modalities was evaluated. Methods: Twenty- four consecutive patients who underwent LPLND between June 1993 and July 1996 were studied. These patients were considered poor surgical candidates based on several risk factors, as follows: elevation of serum PSA >20 in 19 patients (79%); elevation of serum acid phosphatase in 4 patients (17%); digital rectal examination findings indicative of extraprostatic extension or seminal vesical involvement in 14 patients (58%); and poorly differentiated tumors on prostate biopsy in 19 patients (79%). Nineteen patients (79%) had two or more of these risk factors. Median PSA for the entire series of patients was 35.2 ng/mL (range 7.9 to 133 ng/mL), and median Gleason score was 7 (range 5 to 9). Preoperative CT or MRI was negative for pelvic lymph node metastases in 17 of 23 patients (79%), and bone scan was negative in all 24 patients. Results: Unilateral (n = 2) or bilateral (n = 22) LPLND was performed in all patients. Six patients (25%) had lymph node metastases detected laparoscopically. Five of the six patients had palpable extraprostatic extension (T3a/b) or invasion of a seminal vesical (T3c), and in four of these patients the site of the metastatic lymph nodes was ipsilateral to the palpable prostate abnormality. None of the risk factors was independently predictive of lymph node metastases within this series of patients. An average of 10.8 ± 6.5 lymph nodes was removed at a mean operative time of 174 ± 10 minutes for patients undergoing bilateral LPLND. Estimated blood loss was minimal for 20 of 22 patients (92%) undergoing LPLND alone, and there were no complications requiring open exploration. Mean postoperative hospital stay was 1.2 ± 0.5 days for patients undergoing LPLND alone. Conclusions: LPLND can be used efficiently to identify patients with nodal metastases from select high-risk patients. This, in turn, can exclude such patients from noncurative local and regional therapy.

Original languageEnglish
Pages (from-to)173-180
Number of pages8
JournalAnnals of Surgical Oncology
Volume5
Issue number2
DOIs
StatePublished - Mar 1 1998
Externally publishedYes

Fingerprint

Lymph Node Excision
Prostatic Neoplasms
Neoplasm Metastasis
Lymph Nodes
Prostate
Urinary Bladder
Digital Rectal Examination
Neoplasm Grading

Keywords

  • Laparoscopic pelvic lymphadenectomy
  • Nodal metastases
  • Prostate cancer

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Results of laparoscopic pelvic lymphadenectomy in patients at high risk for nodal metastases from prostate cancer. / Kava, Bruce; Dalbagni, Guido; Conlon, Kevin C.; Russo, Paul.

In: Annals of Surgical Oncology, Vol. 5, No. 2, 01.03.1998, p. 173-180.

Research output: Contribution to journalArticle

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abstract = "Background: Laparoscopic pelvic lymphadenectomy (LPLND) can be performed safely and with minimal morbidity in the staging of prostate cancer. Its utility in evaluating patients at high risk for metastatic disease before primarily nonsurgical treatment modalities was evaluated. Methods: Twenty- four consecutive patients who underwent LPLND between June 1993 and July 1996 were studied. These patients were considered poor surgical candidates based on several risk factors, as follows: elevation of serum PSA >20 in 19 patients (79{\%}); elevation of serum acid phosphatase in 4 patients (17{\%}); digital rectal examination findings indicative of extraprostatic extension or seminal vesical involvement in 14 patients (58{\%}); and poorly differentiated tumors on prostate biopsy in 19 patients (79{\%}). Nineteen patients (79{\%}) had two or more of these risk factors. Median PSA for the entire series of patients was 35.2 ng/mL (range 7.9 to 133 ng/mL), and median Gleason score was 7 (range 5 to 9). Preoperative CT or MRI was negative for pelvic lymph node metastases in 17 of 23 patients (79{\%}), and bone scan was negative in all 24 patients. Results: Unilateral (n = 2) or bilateral (n = 22) LPLND was performed in all patients. Six patients (25{\%}) had lymph node metastases detected laparoscopically. Five of the six patients had palpable extraprostatic extension (T3a/b) or invasion of a seminal vesical (T3c), and in four of these patients the site of the metastatic lymph nodes was ipsilateral to the palpable prostate abnormality. None of the risk factors was independently predictive of lymph node metastases within this series of patients. An average of 10.8 ± 6.5 lymph nodes was removed at a mean operative time of 174 ± 10 minutes for patients undergoing bilateral LPLND. Estimated blood loss was minimal for 20 of 22 patients (92{\%}) undergoing LPLND alone, and there were no complications requiring open exploration. Mean postoperative hospital stay was 1.2 ± 0.5 days for patients undergoing LPLND alone. Conclusions: LPLND can be used efficiently to identify patients with nodal metastases from select high-risk patients. This, in turn, can exclude such patients from noncurative local and regional therapy.",
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N2 - Background: Laparoscopic pelvic lymphadenectomy (LPLND) can be performed safely and with minimal morbidity in the staging of prostate cancer. Its utility in evaluating patients at high risk for metastatic disease before primarily nonsurgical treatment modalities was evaluated. Methods: Twenty- four consecutive patients who underwent LPLND between June 1993 and July 1996 were studied. These patients were considered poor surgical candidates based on several risk factors, as follows: elevation of serum PSA >20 in 19 patients (79%); elevation of serum acid phosphatase in 4 patients (17%); digital rectal examination findings indicative of extraprostatic extension or seminal vesical involvement in 14 patients (58%); and poorly differentiated tumors on prostate biopsy in 19 patients (79%). Nineteen patients (79%) had two or more of these risk factors. Median PSA for the entire series of patients was 35.2 ng/mL (range 7.9 to 133 ng/mL), and median Gleason score was 7 (range 5 to 9). Preoperative CT or MRI was negative for pelvic lymph node metastases in 17 of 23 patients (79%), and bone scan was negative in all 24 patients. Results: Unilateral (n = 2) or bilateral (n = 22) LPLND was performed in all patients. Six patients (25%) had lymph node metastases detected laparoscopically. Five of the six patients had palpable extraprostatic extension (T3a/b) or invasion of a seminal vesical (T3c), and in four of these patients the site of the metastatic lymph nodes was ipsilateral to the palpable prostate abnormality. None of the risk factors was independently predictive of lymph node metastases within this series of patients. An average of 10.8 ± 6.5 lymph nodes was removed at a mean operative time of 174 ± 10 minutes for patients undergoing bilateral LPLND. Estimated blood loss was minimal for 20 of 22 patients (92%) undergoing LPLND alone, and there were no complications requiring open exploration. Mean postoperative hospital stay was 1.2 ± 0.5 days for patients undergoing LPLND alone. Conclusions: LPLND can be used efficiently to identify patients with nodal metastases from select high-risk patients. This, in turn, can exclude such patients from noncurative local and regional therapy.

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