The Significance Of Laparoscopic Extended Lymph Node Dissection In The Treatment Of Medium And High-risk Prostate Cancer

Purpose:To evaluate the significance of laparoscopic extended pelvic lymph node dissection in the prostatectomy of medium and high-risk prostate cancer.Methods:From Jan 2014 to Dec 2017,the date of 53 patients with prostate cancer,who accepted the radiacl prostatectomy and extended plevic lymph node dissection were analyzed,retrospectively.All patients were diagnosed as prostate cancer by pathological examination after prostate biopsy or transurethral resection of the prostate,and no distant metastasis was seen with whole-body bone scan and chest CT examination.According to preoperative PSA level,pathological Gleason score,clinical TNM staging(AJCC,2002),risk factor grading(CUA,2014),intermediate-risk group 29(54%),and high-risk group 24(46%).Undergoing laparoscopic radical prostatectomy + extended pelvic lymph node dissection under general anesthesia.The range of lymphadenectomy includes five regions:external iliac,internal iliac,obturator and common iliac lymph nodes bilaterally,and the presacral lymph nodes.Record operating time,intraoperative blood loss,postoperative complications,The number of lymph nodes and the number of pathologically positive lymph nodes in each group and in each region were recorded.The number of lymph nodes removed,the ratio of positive lymph nodes,and the density and distribution of positive lymph nodes in each group and in each region were compared.Results:53 cases had no transfer to open surgery and all were successfully completed.The operation time was 85-155 min,and the intraoperative blood loss was 90-300 ml.Postoperative clinical stage: 24 cases of T2 b,16 cases of T2 c,9 cases of T3 a,and 4 cases of T3 b.In this study,the number of lymph nodes removed during surgery was 1,064,in each case,14 to 36 lymph nodes were removed,with an average of 22.19 patients with positive lymph node metastasis were confirmed by postoperative pathology.The total metastatic rate was 36%(19/53).In these 19 patients,a total of 145 lymph nodes were removed and 45 positive lymph nodes were found.The positive lymph node detection rate was 4.2%(45/1064).The metastatic rates of patients in the intermediate and igh-risk group were 24%(7/29)and 46%(11/24),with no statistically significant difference(P=0.097).The most important area of metastasis-positive lymph node distribution is the internal lilac region.The lymph nodemetastasis rate from high to low in each region was 53%(10/19)in the internal lilac region,42%(8/19)in the obturator region,32%(6/19)in the external iliac region,11%(2/19)in presacral region and 5%(1/19)in common iliac region,The difference was statistically significant(P=0.004).The highest density of positive lymph nodes in each region was: obstructed area 39%(17/44),intraorbital area 29%(18/62),extra-iliac area 26%(7/27),presacral area 25 %(2/8),total sacral area25%(1/4),no statistical difference(P=0.766).Conclusion:1: In addition to the need to focus on obturator,internal and external iliac region,radical excision of pelvic lymph node dissection should also focus on the presacral region.2: RP+ePLND is safe and feasible for patients with intermediate and high risk prostate cancer and can accurately determine the clinical stage.It can guide postoperative further adjuvant therapy.And it is expected to improve the survival rate of patients.