로봇 보조 복강경 근치적 전립선적출술에서 시행한 골반림프절절제술의 의미

Abstract

Purpose: Sometimes, pelvic lymph node dissection(PLND) for prostate cancer is not performed in selective patients during open, laparoscopic and robot-assisted laparoscopic radical prostatectomy(RLRP), although lymph-node staging is important in many patients with prostate cancer, as it influences adjuvant treatment and prognosis. However, PLND adds to the operating time and potential for complications. The objective of the present study was to investigate the significance of PLND during RLRP in different risk groups.

Materials and Methods : Between April 2006 and April 2007, a total of 104 consecutive patients who underwent RLRP and PLND limited to obturator and external iliac lymph nodes were studied. The procedures were performed by single surgeon. Patients were evaluated in three groups based on the prostate-specific antigen(PSA), biopsy Gleason score and clinical stage.

Results: Lymph node metastases were detected in 6 patients(5.8%). There was no lymph node metastasis in low risk group, 1(2.9%) in intermediate risk group and 5(11.4%) in high risk group. The positive lymph nodes were significantly related to other clinicopathological factors, including serum PSA level, clinical and pathological stage and seminal vesicle invasion. Positive nodes were located in the external iliac nodes alone in 2 patients and the obturator nodes alone in 4 patients.

Conclusions : The incidence of lymph node metastasis is low in patients of low risk group and in these patients PLND may be unnecessary. For the high risk group, PLND seems mandatory.