LAPAROSCOPIC PELVIC LYMPH-NODE DISSECTION FOR STAGING OF PROSTATIC-CANCER

Assessment of the pelvic lymph node status is a major concern in prost atic cancer staging. In spite of a normal abdominopelvic CT scan exami nation in patients with organ-confined disease, 7-30% will have lymph node metastases at pathological examination and will not benefit from radical prostatectomy. Laparoscopy enables pelvic lymph node dissectio n via a minimally invasive approach. Twenty-nine patients underwent la paroscopic pelvic lymph node dissection (LPLND) for prostatic cancer s taging. The average duration of the bilateral dissection was 90 +/- 40 min (range 35-180 min). One patient died of a stroke on postoperative day 1, without local complication. The peroperative complications wer e 1 injury of the external iliac vein, 1 ileal injury, 1 ureteral inju ry, all 3 (11%) requiring immediate or delayed laparotomy. One patient had a self-resolving bilateral obturator nerve paresis. A previously irradiated patient had perineal lymphedema for 4 weeks. The average nu mber of lymph nodes removed was 8.4 +/- 3.4 (range 4-17) for bilateral LPLND. Five patients had lymph node metastases. The median length of stay for patients undergoing LPLND as a single procedure was 2 days (r ange 2-11 days). After an operational period, during which the complic ation rate was relatively high, we now consider LPLND as a safe and ef fective procedure for the staging of patients with organ-confined pros tatic cancer, but considering the increased risk of complications duri ng the application period, we do not encourage the generalization of t his technique which should remain restricted to some particular strate gies, as in combination with perineal radical prostatectomy.