Abstract
Treating prostate cancer, pelvic lymphadenectomy is still a debating topic in current international licterature. Surgical removal of both internal iliac vessels and obturatory fossa lymphonodes is usefull in order to stage lymphatic spreading of prostate cancer. We evaluated possible indications to laparoscopic limphadenectomy according to present know-ledges.
Methods
From october 2001 to june 2003, at our instituction 18 consecutive patients with clinically advanced prostate carcinoma diagnosed at transrectal ultrasonography guided needle biopsy and >20% preoperative risk of lymphonode metatstasis, underwent laparoscopic pelvic lymphadenectomy. Patients’ surgical postion in the theatre room was according to classic reported transperitoneal approach. Five disposable trocars were used for optical and instruments access.
Results
Mean surgical intervention time, blood loss and number of removed lymphonodes was 163 ± 32.8 minutes, 180 mL ± 25 and 28.7 ± 8.6 respectively. Ten patients (55%) were diagnosed to have lymphonode metastasis. Mean number of metastatic lymphonodes was 3. Conversion to open surgical procedure was not recorded. In 17 out of 18 cases, analgesic therapy was not necessary during hospital stay; in those patients intestinal canalisation, mobilisation and oral food intake restarted in first postoperative day. We had only one major complication. Laparoscopic pelvic lymphadenectomy costs were € 4.244. Regional diagnosis relata groups fee was € 4.463.
Conclusion
Laparoscopic lymphadenectomy, when indicated, was in our experience safe and effective but still expensive procedure with high patient’ satisfaction.
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