Pelvic lymph node dissection for prostate cancer： clinical significance and management of complications

Objective To discuss the application of pelvic lymph node dissection during radical prostatectomy.Methods The data of 239 patients with prostate cancer which had been done radical prostatectomy and pelvic lymph node dissection were retrospectively reviewed,with the patients＇median age of 68 （48-79） years.148 patients（61.9%） had either a Gleason score of〉7 or a PSA of〉20 ng/ml.All patients were diagnosed as clinical localized prostate cancer preoperatively.The extent of pelvic lymph node dissection included bilateral obturator fossa and region of the external iliac artery.Patients with positive lymph nodes were advised to receive maximal androgen blockade therapy and were followed up until biochemical recurrence.Results It took an average operation time of 20（15-35）min with the average blood loss of 20（5-45） ml for bilateral lymphadenectomy. There was no injury of big vessels and nerves. The total number of lymph node dissected was 1-23 with a median of 7.The median postoperative hospital stay was 16 days.The time of drainage was 4-36 days with a median of 7 days.74.5%（178 cases）of patients had drainage less than 8 days and 9.4%（20 cases）patients were more than 14 days. Positive nodes were found in 29 cases with the positive rate of 12.1%. The median number of positive lymph nodes was 1.Early postoperative complications related to pelvic lymphadenectomy included deep venous thrombosis,lymphocele,lymph leakage,pelvic infection. Patients with positive lymph nodes had a median progression free time of 10 months.Conclusions Pelvic lymph node dissection could detect lymph node metastasis which might be difficult to find through other means. It could facilitate the accurate staging of prostate cancer and bring potential benefits to patients. It does not significantly prolong the operation time and the incidence of complications should decrease gradually with the improvement of the surgeons＇experience and surgical techniques. Key words: Prostatic neophsms;  Carcinoma;  Pelvic lymph node dissection;  Radical prostatectomy;  Complications