| Background:The incidence rate of prostate cancer has increased year by year,and it ranks second in the incidence rate of male malignant tumor,next only to lung cancer.Prostate cancer is more and more threatening to men’s health,especially to the health of elderly men.There are many methods for the treatment of prostate cancer,among which radical prostatectomy is the most effective method for the treatment of patients with localized prostate cancer.Pelvic lymph node dissection in RP has always been a hot spot of controversy.The disputes mainly focus on the selection of surgical patients,the best range of lymph node dissection,the safety of operation,whether there is oncology benefits and so on.Pelvic lymphadenectomy is mainly used for staging diagnosis and treatment of prostate cancer patients.PLND is the most accurate method for the diagnosis of lymph node metastasis.Current guidelines recommend pelvic lymphadenectomy for intermediate-or high-risk prostate cancer patients with high risk of lymph node metastasis.There are many literatures about PLND in radical prostatectomy,but these literatures have high heterogeneity,low quality of evidence,lack of unified evaluation criteria,and many of the conclusions are contradictory.Objective:This study compared and analyzed the differences between non oncology results and oncology results of different degrees of lymph node dissection in LRP,so as to explore the advantages and disadvantages of different degrees of lymph node dissection,to provide valuable reference for clinical work.Methods:The clinical data of 325 patients with LRP in Department of Urology of Shandong provincial hospital from June 2017 to June 2020 were retrospectively analyzed.According to the exclusion and inclusion criteria,a total of 131 intermediate-or high-risk prostate cancer patients were included in this study.According to the degree of PLND,they were divided into no-PLND group(42 cases),1PLND group(52 cases)and ePLND group(37 cases).The preoperative,perioperative,pathological and BCR results were observed.According to preoperative variables including age,TPSA,Gleason score of biopsy,clinical T stage and risk,the matched cohort was obtained by PSM in 1PLND group and ePLND group.Results:(1)There were significant differences in TPSA,the number of puncture positive needles,Gleason score,clinical T stage and risk group among different degrees of PLND groups(P<0.05),but there was no significant difference in age(P>0.05).(2)In the comparison of non-oncology results,there was no significant difference in intraoperative blood loss between different degrees of PLND group(P>0,05),but there were significant differences in operation time and hospital stay between three groups(P<0.05).There was no significant difference in infection,urinary incontinence,anastomotic leakage,inguinal hernia,urethral stricture and positive margin between the groups(P>0.05).The incidence of Lymphocyst in ePLND group was significantly higher than that in 1PLND group(P<0.05).(3)PSM matched 26 patients in each group.In the matcher cohort,the positive rate of lymph nodes in ePLND group was significantly higher than that in 1PLND group(17.8%vs 3.4%,P<0.05).There were total 54 high-risk patients,in which the positive rate of lymph nodes in ePLND group was significantly higher than that in 1PLND group(18.3%vs 3.3%,P<0.05).(4)The median follow-up time was 25.8 months(5.5-38.7).In the PSM cohort,there was no significant difference in the biochemical recurrence free survival rate between the two groups(P<0.05)Conclusion:(1)ePLND can significantly improve the detection rate of lymph node metastasis,but it can significantly increase the operation time,hospital stay and the risk of lymphocyst.(2)PLND is not an independent risk factor for BCR-free survival after prostatectomy.(3)For high-risk patients,ePLND is recommended to increase the detection rate of lymph node metastasis,so as to obtain more accurate pathological staging and provide important guidance for postoperative adjuvant therapy.The role of PLND in low-risk and intermediate-risk patients still needs further study. |
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