Fluorescence-targeted laparoscopic lymph node dissection in prostate cancer.

Abstract

70 Background: Recently we have introduced fluorescence by means of Indocyanin Green(ICG) in addition to radio-guided dissection using Technetium 99(Tc99) for laparoscopic pelvic sentinel node dissection (Urology 2012). Hence we could show that ICG alone gave equal results compared to TC99. Since ICG visualizes the complete drainage system we have as an evolution now left the sentinel concept to completely remove this template. Methods: 38 consecutive men with intermediate and high risk prostate cancer have undergone targeted Lymphnode dissection during laparoscopic radical prostatectomy. 2ml ICG were injected transpeineally into each lobe under TRUS guidance. After removal of the complete ICG visualized Lymphnode template of each side, a standard ePLND was added as control. All Lymphnodes were evaluated by 250 ym sections and imunohistochemistry. Results: Transperineal Injection allowed for precise deposit without any periprostatic extravasation. Fluorescence stained (F+) nodes were found on both sides in all patients except one. In total 596 nodes (17,9 +-8,4/patient) were removed, of which 473 nodes (14,3 +- 8,51/pat.) were F+. LN Metastases were found in 15 pat.(39,5%), of which 2 pat. (5,3 %) had solitary micrometastases. In addition 3 patients (7,9 %) the LN contained Tumor Cell Cluster. No non-stained metastases were found in addition to F+ Metastases. Met outsi de the template of extended PLND occurred in 5 patients(27,8% of N+). Conclusions: Fluorescence-targeted lymphnode dissection allows to identify the lymphatic drainage of the prostate with great reliability. It proved to be more precise than extended lymphnode dissection in patients with intermediate and high grade prostate cancer