Up-to-date indications for laparoscopic pelvic lymph node dissection

Abstract

— After five years experience of laparoscopic pelvic lymph node dissection in the case of clinically localized prostatic carcinoma the indications for such a procedure are nowadays well defined. It is mainly indicated when planning: 1. external or interstitial radiotherapy; 2. perineal radical prostatectomy; 3. retropubic radical prostatectomy in patients at high (more than 40%) risk for nodal metastases. In the past, up to 30% patients pre-operatively supposed NO, proved to be pathologically N +; nowadays the great development in diagnostic methods (expecially PSA) allows for a dramatic reduction of that figure and consequently the impact of pelvic node laparoscopic staging will become less important. In future laparoscopic pelvic lymph node dissection might be reserved for selected patients for perineal prostatectomy (if it regains popularity).