LAPAROSCOPIC PELVIC LYMPH-NODE DISSECTION FOLLOWING DEFINITIVE RADIOTHERAPY FOR CARCINOMA OF THE PROSTATE

Purpose: Laparoscopic pelvic lymph node dissection is an effective and minimally invasive approach to the clinical staging of adenocarcinoma of the prostate. We report our experience with this technique in pati ents in whom full course pelvic radiotherapy had failed and who were b eing considered for salvage local therapy. Materials and Methods: In 1 4 patients disease was staged by transperitoneal laparoscopic pelvic l ymph node dissection performed for persistent adenocarcinoma of the pr ostate at least 20 months (average 49.5) following external beam radio therapy and/or brachytherapy. All patients were healthy, had no eviden ce of metastatic disease and were considered to be candidates for salv age therapy. Results: A total of 13 patients underwent successful lapa roscopic pelvic lymph node dissection while 1 sustained an enterotomy requiring conversion to open surgery. The normal surgical planes were more difficult to dissect, with the obturator lymph node packets appea ring smaller and more fibrotic than in nonirradiated patients, yieldin g an average of 7.1 total nodes. Average operative time was 167 minute s and postoperative hospitalization was comparable to reported series of nonirradiated patients. Four patients (28%) with metastatic pelvic lymph nodes underwent subsequent orchiectomy. Nine patients with negat ive lymph nodes underwent ultrasound guided transperineal placement of radioactive gold or palladium seeds. One patient underwent salvage ra dical retropubic prostatectomy. Conclusions: Laparoscopic pelvic lymph node dissection following full course pelvic irradiation is technical ly feasible, albeit more difficult than in nonirradiated patients. Thi s approach appears to be an excellent minimally invasive technique for the clinical restaging of persistent adenocarcinoma of the prostate i n patients being considered for salvage therapy.