Application of sentinel node navigation surgery to prostate cancer

: A sentinel node (SN) validation study using a radioactive tracer and back-up extended pelvic lymph node (LN) dissection was performed in 40 patients with non-metastatic prostate cancer (PCa). The results of the study were favorable, with sensitivity, specificity, and accuracy of SN biopsies revealed 90%, 100%, and 97.5%, respectively. Although 1 patient had false negative LNs, the SN concept was still validated because extensive LN metastasis disrupted the physiological lymphatic flow in this case. Based on our promising results to date, we examined the utility of SN navigation surgery (SNNS) in patients with LN metastasis probability of 10% or less on Partin tables. Endoscopic minilaparotomy surgery, established by Kihara et al., was applied to our SN biopsies in 9 patients with clinically localized PCa. SNs were successfully resected in 7 of these patients. Limited pelvic LN dissection was performed in 3 patients, including 1 patient with LN metastasis. SN biopsy and radical prostatectomy were performed via a 5-cm lower abdominal incision. In summary, endoscopic minilaparotomy SNNS is a less invasive form of radical surgery for PCa that offers accurate diagnosis of LN status.