Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer
Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer
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DOI：
10.1016/j.eururo.2006.08.015
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发表时间：
2006-11-01
期刊：
影响因子：
23.4
通讯作者：
Karakiewicz, Pierre I.
中科院分区：
文献类型：
--
作者：
Briganti, Alberto;Chun, Felix K. -H.;Karakiewicz, Pierre I.
目的：与局限性盆腔淋巴结清扫术（PLND）相比，更广泛的盆腔淋巴结清扫术可能并发症发生率更高且住院时间更长。
方法：在耻骨后根治性前列腺切除术前，对963例患者进行了盆腔淋巴结清扫术。其中，767例（79.6%）切除并检查了≥10个淋巴结（扩大的盆腔淋巴结清扫术[ePLND]），而其余196例（20.4%）切除了1 - 9个淋巴结（局限性盆腔淋巴结清扫术[lPLND]）。清扫范围包括髂外、闭孔、髂内和髂总分叉处。前瞻性地记录与盆腔淋巴结清扫术相关的并发症及住院时间，并根据盆腔淋巴结清扫术的范围进行分析。
结果：接受扩大盆腔淋巴结清扫术的患者总体并发症发生率为19.8%，而接受局限性盆腔淋巴结清扫术的患者为8.2%（p < 0.001）。在对特定并发症的单独分析中，只有淋巴囊肿发生率在扩大盆腔淋巴结清扫术后显著更高（10.3%对4.6%；p = 0.01）。同样，扩大盆腔淋巴结清扫术导致住院时间更长（9.9天对8.2天；p < 0.001）。当对前列腺特异性抗原以及临床或病理肿瘤特征进行调整后，这些差异仍然存在。
结论：我们的数据表明，即使由经验丰富的泌尿外科医生操作，扩大盆腔淋巴结清扫术也与更高的并发症发生率和更长的住院时间相关。在考虑扩大盆腔淋巴结清扫术的分期益处时，需要考虑到这些不利因素。（c）2006年欧洲泌尿外科学会。由爱思唯尔公司出版。保留所有权利。
Objectives: More-extensive pelvic lymph node dissection (PLND) may be associated with a higher rate of complications and a longer hospital stay than more limited PLND.Methods: Before radical retropubic prostatectomy, PLNDs were performed in 963 patients. Of these, 767 (79.6%) had >= 10 lymph nodes removed and examined (extended PLND [ePLND]), while 1-9 nodes (limited PLND [lPLND]) were removed in the remaining 196 (20.4%). Limits included external iliac, obturator, internal iliac, and iliac bifurcation. PLND-related complications and the length of hospital stay were recorded prospectively and analyzed according to the extent of PLND.Results: In patients subjected to ePLND, the overall rate of complications was 19.8% versus 8.2% in those treated with lPLND (p < 0.001). In individual analyses of specific complications, only the lymphocele rate was significantly higher after ePLND (10.3% vs 4.6%; p=0.01). Similarly, ePLND translated into a longer hospital stay (9.9 vs 8.2 d; p < 0.001). These differences persisted when adjustment was made for prostate-specific antigen and either clinical or pathologic tumor characteristics.Conclusions: Our data indicate that, even in the hands of experienced urologic surgeons, ePLNDs are associated with higher complication rates and longer hospital stay. These detriments need to be taken into account when the staging benefit associated with ePLND is considered. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.