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Laparoscopic pelvic lymph node dissection following definitive radiotherapy for carcinoma of the prostate. J Urol 1997 Feb;157(2):548-51 PMID: 8996353

Pubmed ID

8996353

Abstract

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 patients in whom full course pelvic radiotherapy had failed and who were being considered for salvage local therapy.

MATERIALS AND METHODS: In 14 patients disease was staged by transperitoneal laparoscopic pelvic lymph node dissection performed for persistent adenocarcinoma of the prostate at least 20 months (average 49.5) following external beam radiotherapy and/or brachytherapy. All patients were healthy, had no evidence of metastatic disease and were considered to be candidates for salvage therapy.

RESULTS: A total of 13 patients underwent successful laparoscopic 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 appearing smaller and more fibrotic than in nonirradiated patients, yielding an average of 7.1 total nodes. Average operative time was 167 minutes 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 negative lymph nodes underwent ultrasound guided transperineal placement of radioactive gold or palladium seeds. One patient underwent salvage radical retropubic prostatectomy.

CONCLUSIONS: Laparoscopic pelvic lymph node dissection following full course pelvic irradiation is technically feasible, albeit more difficult than in nonirradiated patients. This approach appears to be an excellent minimally invasive technique for the clinical restaging of persistent adenocarcinoma of the prostate in patients being considered for salvage therapy.

Author List

Lund GO, Winfield HN, Donovan JF, See WA, Loening SA, Williams RD

Author

William A. See MD Chair, Professor in the Urologic Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-0031033709   7 Citations

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Aged
Follow-Up Studies
Humans
Laparoscopy
Lymph Node Excision
Male
Middle Aged
Prostatic Neoplasms
Retrospective Studies
jenkins-FCD Prod-336 69ef4a6b262d135130251597d5d39873903802b5