前立腺早期癌における腹腔鏡下骨盤リンパ節郭清術の経験

Abstract

1991年1月から9月に, 前立腺癌stage A2, B1, Cの3症例(年齢65～77歳)に対して, 腹腔鏡下骨盤リンパ節郭清術を施行した.手術時間は3時間40分から4時間30分で, 術中術後に合併症はなかった.左右併せて5～10個のリンパ節を摘除できたが, 病理組織診断は3症例とも転移を認めなかった.腹腔鏡下骨盤リンパ節郭清術は, 限局性前立腺癌のうち, stage C, 血清PSA高値, 低分化癌などリンパ節転移の頻度の高い症例, あるいは, 放射線治療や経会陰式前立腺摘除を行い症例では有用と考えられる

Laparoscopic pelvic lymphadenectomy is a newly developed technique of lymph node dissection in patients with malignancy of the pelvic organs. Three patients with localized prostatic cancer underwent laparoscopic pelvic lymphadenectomy. The patients were 77 years old with stage C disease, 73 with stage B1, and 65 with stage A2. Five to ten lymph nodes were removed from each patient after laparoscopic procedures lasting 220 to 270 minutes. There were no complications during the procedures and their convalescence was uneventful. All lymph nodes were negative by pathological examination and a radical retropubic prostatectomy was done 2 weeks after the lymphadenectomy in two patients. The other patient was treated with external radiotherapy and bilateral orchiectomy. Patients with stage C cancer, a high serum level of prostate specific antigen or a high grade tumor are the best candidates for this less invasive staging procedure. The disadvantage of this procedure is long operation time and complications due to CO2 pneumoperitoneum.