A NEW MINIMALLY INVASIVE OPEN PELVIC LYMPHADENECTOMY SURGICAL TECHNIQUE FOR THE STAGING OF PROSTATE-CANCER

We report a new method for lymphadenectomy, the minilaparotomy (inguin al) pelvic lymph node dissection (MLPLND), and compare it with laparos copic pelvic lymph node dissection (LPLND) in terms of cost, effective ness, operation time, and morbidity. We reviewed a series of 111 conse cutive patients: 51 had MLPLND and 60 had LPLND. All patients had prov ed adenocarcinoma of the prostate by biopsy. Of the MLPLND patients, o nly 1 had to stay overnight in the hospital, and all left within 24 ho urs. Pelvic lymphadenectomy consisted of nodal removal along the inter nal iliac vessels and the external iliac vein, and nodes of the obtura tor foramen. A total of 14% of the patients had disease involving the lymph nodes. The cost of MLPLND was 50% of the cost of LPLND, with no intraoperative or postoperative morbidity. This new operation can be p erformed thoroughly and inexpensively in approximately 35 minutes, wit h little or no morbidity. Since the drawbacks of laparoscopic techniqu es associated with instrument costs and the learning curve for this te chnically difficult operation are eliminated, staging pelvic lymphaden ectomy can be performed routinely on a wider variety of patients with potential metastatic disease. Currently, we recommend MLPLND to any pa tient with a tumor of Gleason score 7 or higher or a serum prostate-sp ecific antigen value of 15 ng/mL or higher.