Staging laparoscopic pelvic lymphadenectomy in prostate cancer

Objective To assess the results of transperitoneal laparoscopic pelvic lymp hadenectomy as a separate staging procedure in patients with early prostate cancer. Patients and methods The results were reviewed from the first 27 patients w ith prostate cancer admitted for laparoscopic lymphadenectomy between Janua ry 1994 and March 1998. initially, all patients with a negative bone scan a nd either a negative computed tomography or negative magnetic resonance sca n were admitted for laparoscopic staging. After several reports detailing w ays of reducing the number of negative lymphadenectomy operations, from Jul y 1996 only those patients with a preoperative prostate specific antigen (P SA) serum level of > 10 ng/mL were admitted to the study. All procedures we re performed by one experienced laparoscopic surgeon. A radical retropubic prostatectomy was performed as a separate procedure by a consultant urologi st within 2 weeks. The effectiveness of the staging operation was analysed by assessing the nodal yield, and the results, including operative duration , complications and length of stay, were compared with other published seri es. Further analysis was provided by reviewing the PSA levels, Gleason grad e sum and clinical digital staging, Results The nodal yield was similar to that published in series from other institutions, with a median (range) of 6.5 (0-12). However, the operation w as significantly quicker, at a median (range) of 55 (40-110) min for a bila teral dissection. There were only minor complications, with no detectable r eduction in complications with experience; the median (range) postoperative stay was 1 (1-4) days. Two of the 27 patients had metastatic disease withi n the lymph nodes. If a PSA level of > 10 ng/mL had been instituted as an e ntry criteria at the start of the study, six patients would have been exclu ded and thus the positive lymphadenectomy rate would have been two of 21 pa tients (10%). Of 54 patients eligible to enter the study, half did not requ ire a lymphadenectomy. Conclusions Laparoscopic transperitoneal lymphadenectomy can be performed e xpeditiously and safely. A two-stage procedure in some patients with prosta te cancer is the management of choice, Attention to carefully closing the p eritoneum with sutures minimizes any retropubic adhesions and no problems a ssociated with the staging procedure were encountered during subsequent rad ical retropubic prostatectomy, In efforts to reduce negative staging lympha denectomies, the exclusion values for staging should not be set too high (P SA and Gleason grading sum). Such practice, despite a relatively safe stagi ng procedure, would lead to unnecessary radical prostatectomy.