STAGING PELVIC LYMPHADENECTOMY FOR LOCALIZED CARCINOMA OF THE PROSTATE - A COMPARISON OF 3 SURGICAL TECHNIQUES

Purpose: Pelvic lymph node dissection continues to be the most effecti ve method of staging extracapsular adenocarcinoma of the prostate. Thr ee principal methods of pelvic lymph node dissection are currently ava ilable: intraperitoneal laparoscopic, minilaparotomy and the standard open modified pelvic lymph node dissection. In the hope of determining some of the relative advantages and disadvantages associated with eac h technique a comparison of these approaches was made. Materials and M ethods: Of 68 patients with histologically proved clinical stage T3N0M 0 adenocarcinoma of the prostate who underwent staging pelvic lymph no de dissection 38 underwent modified open, 19 laparoscopic and 11 minil aparotomy procedures. The efficacy of node sampling, resource expendit ure and complication rates were compared among the 3 groups. Results: No statistically significant difference was observed in terms of the n umber of nodes harvested with each technique. Resource expenditure ana lysis revealed significantly increased operative and procedural time r equirements for laparoscopic pelvic lymph node dissection compared to modified open and minilaparotomy procedures. Total hospital stay was s ignificantly longer for the modified open pelvic lymph node dissection (mean plus or minus standard deviation 6.5 +/- 0.9 days) compared to the laparoscopic (mean 2.7 +/- 1.1 days) and minilaparotomy (mean 3.3 +/- 0.2 days) groups. Multiple complications, such as ileus, lymphocel e and urinary retention, were observed in the modified open pelvic lym ph node dissection group. No complications were noted in the other 2 g roups. Conclusions: Comparison of laparoscopic and minilaparotomy proc edures to modified open pelvic lymph node dissection revealed similar staging efficacy, and decreased total hospital stay and complications. Laparoscopic pelvic lymph node dissection required increased operativ e time. Minilaparotomy should become the open surgical procedure of ch oice for pelvic lymph node dissection, particularly at institutions wh ere the laparoscopy learning curve, equipment expense and time disadva ntages cannot be overcome.