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Contemporary minimally‐invasive extended pelvic lymph node dissection for prostate cancer before curative radiotherapy: Prospective standardized analysis of complications
Author(s) -
Van Praet Charles,
Decaestecker Karel,
Fonteyne Valérie,
Ost Piet,
De Visschere Pieter,
Verschuere Stephanie,
Rottey Sylvie,
Lumen Nicolaas
Publication year - 2014
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12534
Subject(s) - medicine , lymphocele , dissection (medical) , lymph node , prostate cancer , surgery , radiology , radiation therapy , complication , cancer
Objectives To prospectively assess contemporary complication rates of minimally‐invasive staging pelvic lymph node dissection before curative radiotherapy for prostate cancer using a standardized classification. Methods A total of 100 prostate cancer patients underwent laparoscopic or robot‐assisted pelvic lymph node dissection (95% extended). Surgical outcomes were compared with those of 43 patients undergoing open pelvic lymph node dissection (33% extended). Complications were recorded prospectively during hospitalization and follow‐up visits, and graded using C lavien– D indo classification. Lymphocele size was measured on postoperative magnetic resonance imaging or computed tomography. Results Of the complications recorded, 10% were grade 1, 3% were grade 2 and 6% were grade 3. No grade 4–5 complications occurred. Compared with open pelvic lymph node dissection, minimally‐invasive pelvic lymph node dissection was associated with less blood loss ( P = 0.001) and shorter hospital stay (median 3 vs 6 days; P < 0.001), but longer operation time (130 vs 98 min; P < 0.001). The complication rate was similar in both groups. For the entire cohort, overall and symptomatic lymphoceles were seen in 91 (64%) and 18 patients (13%), respectively. On multivariate logistic regression, minimally‐invasive surgery was the only independent predictor for lymphocele development (odds ratio 3.99; P = 0.015). Conclusions Minimally‐invasive extended pelvic lymph node dissection before curative radiotherapy is associated with low morbidity. Asymptomatic lymphocele development rate is higher compared with open pelvic lymph node dissection.