Comparison of lymph node dissection and short-term efficacy of laparoscopic radical operation in patients with different grades of prostate cancer

Abstract

Objective To investigate and compare pelvic lymph node dissection and the short-term efficacy of laparoscopic radical operation in patients with different Gleason grades of prostate cancer. Methods The medical records of 98 patients with prostate cancer treated by laparoscopic radical operation in our hospital were analyzed retrospectively. According to the preoperative Gleason score, the patients were divided into group A (Gleason score ≤ 6 points, 37 cases), group B (Gleason score of 3+ 4=7 points or 4+ 3=7 points, 42 cases) and group C (Gleason score≥ 8 points, 19 cases). The situation of operation, the incidence of postoperative complications, preoperative and postoperative prostate specific antigen (PSA) levels and the probability of postoperative PSA level > 0.2 ng/mL were compared among the 3 groups. All patients were followed up to August 2017, and the biochemical recurrence rates of two groups were recorded. Results There was no patient undergoing lymph node dissection in group A, 38 patients undergoing pelvic lymph node dissection in group B, and all patients undergoing pelvic lymph node dissection in group C. There was no significant difference between group B and group C in the number of dissected lymph nodes (P>0.05). The operation time and intraoperative blood loss of group A were shorter or less than those of group B or group C (P 0.05). The positive rates of incisal margin in group A and group B (0% and 2.38%) were lower than that in group C (15.79%) (P 0.05). PSA levels in the 3 groups at 1 month after operation were lower than those before operation (P 0.05). The odds of PAS level > 0.2 ng/mL in group A and group B (0 and 2.38%) were significantly lower than that in group C (15.79%) (P<0.05). The biochemical recurrence rates of group A and group B (2.70% and 7.14%) were lower than that of group C (26.32%) (P<0.013). Conclusions Lymph node dissection should be carried out after evaluating the risk of pelvic lymph node dissection in patients with prostate cancer before laparoscopic radical operation. The lower the Gleason score is, the lower the positive margin rate of incisal margin and biochemical recurrence rate are. Key words: Prostatic Neoplasms; Laparoscopy; Lymph Node Excision