ロボット支援体腔鏡下前立腺全摘除術導入期における骨盤内リンパ節郭清の安全性および妥当性における検討

Abstract

To evaluate the safety and adequacy of pelvic lymph node dissection (LND) in robot-assisted laparoscopic radical prostatectomy (RALP) in an institutional introductory case series, we retrospectively reviewed the first 135 patients with clinically localized prostate cancer who underwent RALP with no LND (n＝78), limited LND (LLND, n＝40), or extended LND (ELND, n＝17). Data were collected foroperating time itemized by each surgical procedure, estimated blood loss, lymph node yield, total postoperative drainage amount, postoperative days to drainage tube removal and urethral catheter removal, perioperative complication, and postoperative hospital stay. LLND and ELND took a median of 19 (interquartile range 15-22) and 69 (60.5-91) min, respectively. Total operating time was significantly longer (p＜0.0001) for those with ELND (median 329 min ; interquartile 272-375) than those with no LND (239 ; 195-292) and LLND (281 ; 230-314). Lymph node yield was 7 (5-9) and 23 (12-30) for LLND and ELND, respectively, which was equivalent to the yield of lymph nodes dissected in open prostatectomy ashistorical and institutional control. Although total drainage amount was significantly greater and drainage tube was placed significantly longer in the ELND group, there were no significant differences in time to urethral catheter removal and postoperative hospital stay among the groups. There were no severe perioperative complications associated with LND except for prolonged lymph fistula in each case of the LLND and ELND groups. In conclusion, LND can be performed safely and adequately in introductory RALP cases.