Laparoscopic extended pelvic lymphadenectomy for staging can be performed with limited morbidity and short hospital stay in patients with prostate cancer.

Abstract

Objective: Assessing lymph-node status in prostate cancer patients with high accuracy is only possible with surgical staging, despite the evolution of modern imaging techniques. The use of surgical staging has to be balanced against the complications of the procedure, the individual patient's risk for harbouring metastases and the consequences for the treatment of the patient if such metastases are present. The aim of this study was to investigate complications at 90 days using a standardized method (Clavien) in a consecutive series of patients submitted to laparoscopic extended pelvic lymphadenectomy.

Material and methods: This population-based study included 133 high-risk prostate cancer patients scheduled for external beam radiation. Laparoscopic extended pelvic lymphadenectomy and registration of complications were performed in a standardized fashion. Complications were registered on a five-grade scale, and differences between groups were compared with the chi-squared test.

Results: The mean hospital stay was 1.3 days. Only three patients (2%) suffered from grade 3 complications after surgery, whereas 35 patients (26%) had grade 1 complications and another 11 patients (8%) were treated for grade 2 complications. Of all patients, 35% had lymph-node metastasis, of whom 50% received intensified oncological treatment including adjuvant androgen deprivation and regional lymph-node radiation. Thus, 65% of the patients could be spared regional lymph-node radiation and its associated long-term toxicity.

Conclusions: Laparoscopic extended pelvic lymphadenectomy can be performed with minimal significant complications and short hospital stay in patients with high-risk prostate cancer.