前立腺全摘除術における拡大リンパ節郭清と限局リンパ節郭清の前向き比較検討

Abstract

Patients undergoing radical prostatectomy at our hospital from January 1995 until March 2008 were subjected to limited lymphadenectomy involving only the obturator nerve lymph node. In contrast to published reports, of 488 biopsies, we encountered only three cases of lymph node metastasis. Therefore, starting in April 2008, we conducted a prospective study of limited versus extended lymphadenectomy, the latter involving the obturator fossa and internal iliac lymph nodes. One hundred patients undergoing radical prostatectomy from April 2008 until January 2010 were divided into two groups depending on whether they underwent extended lymphadenectomy (n＝49) or limited lymphadenectomy (n＝51). There were no significant differences in the patient background, estimated blood loss, or operation time between the two groups. Lymphnode metastases were not detected in either group. A significantly greater number of lymph nodes was obtained from the extended lymphadenectomy group (average 14.1) than from the limited lymphadenectomy group (average 8.3 ; p＜0.01). Complications possibly attributable to lymphadenectomy included lymphocele in two patients in the limited group and one patient in the extended group. Extended lymphadenectomy was determined to be a safe procedure that provides the pathologist with a large sample size. None of the patients in either group harbored a detectable lymph node metastasis.