Clinical analysis of standardized extended pelvic lymph node dissection in radical prostatectomy

Abstract

Objective To describe a standardized surgical technique and clinical efficacy of extended pelvic lymph node dissection (e-PLND) in prostate cancer patients. Methods The data of 127 prostate cancer patients with radical prostatectomy and extended pelvic lymph node dissection (e-PLND) from January 2004 to December 2014 were analyzed retrospectively. The mean age was 66.2 (47-78) years, preoperative PSA 13.1 μg /L, Gleason score 6.8. Risk group assessment showed low risk of 49 patients, medium risk of 46 patients, high risk of 32 patients. The pelvic lymph nodes were divided into 9 regions in 5 groups according to the common guideline, namely the external iliac, internal iliac, obturator and common iliac lymph nodes bilaterally, and the presacral lymph nodes. All surgical procedures were understood radical prostatectomy + e-PLND through abdominal incision under general anesthesia. The rates of lymph node metastasis at low risk, medium risk, and high risk group were compared. Relatively metastatic frequency of lymph nodes groups at the different anatomical area with node-positive lymph node patients. Intraoperative and postoperative complications were observed. And serum PSA was checked once every 3 months at postoperative 3 months, the biochemical recurrence was observed. Overall survival was calculated by Kaplan-Meier at 3, 5, and 10-year. Results Among 127 patients, 104 patients were lymph node dissection 5 groups, 23 patients of cleaning the obturator, internal iliac, external iliac, common iliac lymph nodes 4 groups. Totally, 2 727 lymph nodes were dissected. The average number of removed lymph nodes was 21.5(range 13-41). Lymph nodes metastases were detected in 26 of 127 patients (20.5%), including 2.0%(1/49) with low risk group, 23.9%(11/46) with intermediate risk group and 43.8%(14/32) in high risk group (P<0.01). The metastatic frequency of lymph node groups in these patients from higher to lower were as follows: 57.7%(15/26) in internal lilac region, 50%(13/26) in obturator region, 30.8%(8/26) in external iliac region, 11.5%(3/26) in presacral region and 3.8%(1/26) in common iliac region. The intraoperative and postoperative overall complication was diagnosed in 19 of 127 patients (15.0%). Intraoperative venous injury was 2 patients, postoperative lymphatic leakage 5 patients, the lymphocele 10 patients, the lower extremities embolism 2 patients. They were appropriately cured after symptomatic treatment. We had no patients with lymphedema of the lower extremities. Pathological stage were pT1 13, pT2 50, pT3a 49, pT3b 15. One hundred and seventeen patients were followed up postoperatively, the time was 12-123 months, an average of 42.7 months. Biochemical recurrence was 27 patients(23.1%), of which 3 patients died because of tumor recurrence and distant metastasis. Other cause of death was 5 patients. The 3-, 5-, and 10-year accumulate survival rates for all patients were 88.9%(56/63), 78.0%(32/41), and 11/18, respectively. Conclusions The standardization of e-PLND can remove lymph nodes metastasis in radical prostatectomy more thoroughly. It is conducive to determine the anatomical localization of lymph node metastasis, the pathological staging is accurate, which can improve the quality of surgery and improve survival. Key words: Prostatic neoplasms; Prostatectomy; Lymph node excision; Surgical technique