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Staging Laparoscopic Pelvic Lymph Node Dissection: Experience and Indications

Staging Laparoscopic Pelvic Lymph Node Dissection: Experience and Indications Abstract • Laparoscopic pelvic lymph node dissection has proven to be a reliable, less-invasive method for staging prostate cancer. Presently, no clear indications for its performance prior to radical retropubic prostatectomy are available. With the purpose of identifying clinical parameters by which to better select patients who would benefit from laparoscopic pelvic lymph node dissection, we chose to perform the procedure only in patients considered at high risk for nodal metastasis: clinical stages B2 or C, poorly differentiated tumors, and/or a serum prostatic-specific antigen level of more than 20 ng/dL. We compared the results with those of patients not meeting such parameters. Of 80 men receiving treatment for clinically localized disease, 30 (38%) fulfilled one or more of the criteria. When considering the individual clinical parameters, clinical stage was predictive of nodal involvement in five (26%) of 19 patients, grade was predictive in three (37.5%) of eight patients, and prostatic-specific antigen level was predictive in six (40%) of 15 patients. Statistical analysis confirmed that the prostatic-specific antigen level was the single best predictor of nodal involvement. However, better predictive values were obtained when the different criteria were combined. Nodal involvement was predicted most consistently by a combination of clinical stage and prostatic-specific antigen level. (Arch Surg. 1992;127:1294-1297) References 1. Kramer SA, Cline WA, Farnham R, et al. Prognosis of patients with stage D1 prostatic adenocarcinoma . J Urol . 1981;125:817-819. 2. Gervasi LA, Mata J, Easley JD, et al. Prognostic significance of lymph nodal metastases in prostate cancer . J Urol . 1989;142:332-336. 3. Morgan CL, Calkins RF, Cavalcanti EJ. Computed tomography in the evaluation, staging, and therapy of carcinoma of the bladder and prostate . Radiology . 1981;140:751-761.Crossref 4. Biondetti PR, Lee JK, Ling D, Catalona WJ. Clinical stage B prostatic carcinoma: staging with MR imaging . Radiology . 1987;162:325-329.Crossref 5. Hricak H, Dooms GC, Jeffrey RB, et al. Prostatic carcinoma: staging by clinical assessment , CT, and MR imaging. Radiology . 1987;162:331-336.Crossref 6. Partin AW, Carter HB, Chand DW, et al. Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia . J Urol . 1990;143:747-751. 7. Oesterling JE. Prostate specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate . J Urol . 1991;145: 907-923. 8. Flanigan RC, Mohler JL, King CT, et al. Preoperative lymph node evaluation in prostatic cancer patients who are surgical candidates: the role of lymphangiography and computerized tomography scanning with directed fine needle aspiration . J Urol . 1985;134:84-87. 9. Paul DB, Loening SA, Narayana AS, Culp DA. Morbidity from pelvic lymphadenectomy in staging carcinoma of the prostate . J Urol . 1983;129: 1141-1144. 10. Schuessler WW, Vancaillie TG, Reich H, Griffith DP. Transperitoneal endosurgical lymphadenectomy in patients with localized prostate cancer . J Urol . 1991;145:988-991. 11. Parra RO, Andrus CA, Boullier J. Staging laparoscopic pelvic lymph node dissection: comparison of results with open pelvic lymphadenectomy . J Urol . 1992;147:875-878. 12. Donohue RE, Mani JH, Whitesel JA, Augspurger RR, William G, Fauver HE. Intraoperative and early complications of staging pelvic lymph node dissection in prostatic adenocarcinoma . Urology . 1990;35:223-227.Crossref 13. Gleason DF, Mellinger GT, the Veterans Administration Cooperative Urological Research Group. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging . J Urol . 1974; 111:58-64. 14. Kramer SA, Spahr J, Brendler CB, Glenn JF, Paulson DF. Experience with Gleason histopathologic grading in prostatic cancer . J Urol . 1980;124: 223-225. 15. Paulson DF, Uro-Oncology Research Group. Predictors of lymphatic spread in prostatic adenocarcinoma . J Urol . 1980;123:697-699. 16. Oesterling JE, Brendler CB, Epstein JI, Kimball AW Jr, Walsh PC. Correlation of clinical stage, serum prostatic acid phosphatase and preoperative Gleason grade with final pathological stage in 275 patients with clinically localized adenocarcinoma of the prostate . J Urol . 1987;138:92-98. 17. Zincke H, Farrow GM, Myers RP, Benson RC Jr, Furlow WL, Utz DC. Relationship between grade and stage of adenocarcinoma of the prostate and regional pelvic lymph node metastases . J Urol . 1982;128:498-501. 18. Sagalowsky Al, Milam H, Revely LR, Silva FG. Prediction of lymphatic metastases by Gleason histologic grading in prostate cancer . J Urol . 1982;128:951-952. 19. Badalament RA, O'Toole RV, Young DC, York JP, Drago JR. DNA ploidy and prostate-specific antigen as prognostic factors in clinically resectable prostate cancer . Cancer . 1991;67:3014-3023.Crossref 20. Heller JE. Prostatic acid phosphatase: its current clinical status . J Urol . 1987;137:1091-1103. 21. Catalona WJ, Smith DS, Ratliff TL, et al. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer . N Engl J Med . 1991;324:1156-1161.Crossref 22. Hudson MA, Bahnson RR, Catalona WJ. Clinical use of prostate specific antigen in patients with prostate cancer . J Urol . 1989;142:1011-1017. 23. Lange PH, Ercole CJ, Lightner DJ, Fraley EE, Vessella R. The value of serum prostate specific antigen determination before and after radical prostatectomy . J Urol . 1989;141:873-879. 24. Lange PH. Prostate-specific antigen for staging prior to surgery and for early detection of recurrence after surgery . Urol Clin North Am . 1990;17: 813-817. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Staging Laparoscopic Pelvic Lymph Node Dissection: Experience and Indications

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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1992.01420110036009
Publisher site
See Article on Publisher Site

Abstract

Abstract • Laparoscopic pelvic lymph node dissection has proven to be a reliable, less-invasive method for staging prostate cancer. Presently, no clear indications for its performance prior to radical retropubic prostatectomy are available. With the purpose of identifying clinical parameters by which to better select patients who would benefit from laparoscopic pelvic lymph node dissection, we chose to perform the procedure only in patients considered at high risk for nodal metastasis: clinical stages B2 or C, poorly differentiated tumors, and/or a serum prostatic-specific antigen level of more than 20 ng/dL. We compared the results with those of patients not meeting such parameters. Of 80 men receiving treatment for clinically localized disease, 30 (38%) fulfilled one or more of the criteria. When considering the individual clinical parameters, clinical stage was predictive of nodal involvement in five (26%) of 19 patients, grade was predictive in three (37.5%) of eight patients, and prostatic-specific antigen level was predictive in six (40%) of 15 patients. Statistical analysis confirmed that the prostatic-specific antigen level was the single best predictor of nodal involvement. However, better predictive values were obtained when the different criteria were combined. Nodal involvement was predicted most consistently by a combination of clinical stage and prostatic-specific antigen level. (Arch Surg. 1992;127:1294-1297) References 1. Kramer SA, Cline WA, Farnham R, et al. Prognosis of patients with stage D1 prostatic adenocarcinoma . J Urol . 1981;125:817-819. 2. Gervasi LA, Mata J, Easley JD, et al. Prognostic significance of lymph nodal metastases in prostate cancer . J Urol . 1989;142:332-336. 3. Morgan CL, Calkins RF, Cavalcanti EJ. Computed tomography in the evaluation, staging, and therapy of carcinoma of the bladder and prostate . Radiology . 1981;140:751-761.Crossref 4. Biondetti PR, Lee JK, Ling D, Catalona WJ. Clinical stage B prostatic carcinoma: staging with MR imaging . Radiology . 1987;162:325-329.Crossref 5. Hricak H, Dooms GC, Jeffrey RB, et al. Prostatic carcinoma: staging by clinical assessment , CT, and MR imaging. Radiology . 1987;162:331-336.Crossref 6. Partin AW, Carter HB, Chand DW, et al. Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia . J Urol . 1990;143:747-751. 7. Oesterling JE. Prostate specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate . J Urol . 1991;145: 907-923. 8. Flanigan RC, Mohler JL, King CT, et al. Preoperative lymph node evaluation in prostatic cancer patients who are surgical candidates: the role of lymphangiography and computerized tomography scanning with directed fine needle aspiration . J Urol . 1985;134:84-87. 9. Paul DB, Loening SA, Narayana AS, Culp DA. Morbidity from pelvic lymphadenectomy in staging carcinoma of the prostate . J Urol . 1983;129: 1141-1144. 10. Schuessler WW, Vancaillie TG, Reich H, Griffith DP. Transperitoneal endosurgical lymphadenectomy in patients with localized prostate cancer . J Urol . 1991;145:988-991. 11. Parra RO, Andrus CA, Boullier J. Staging laparoscopic pelvic lymph node dissection: comparison of results with open pelvic lymphadenectomy . J Urol . 1992;147:875-878. 12. Donohue RE, Mani JH, Whitesel JA, Augspurger RR, William G, Fauver HE. Intraoperative and early complications of staging pelvic lymph node dissection in prostatic adenocarcinoma . Urology . 1990;35:223-227.Crossref 13. Gleason DF, Mellinger GT, the Veterans Administration Cooperative Urological Research Group. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging . J Urol . 1974; 111:58-64. 14. Kramer SA, Spahr J, Brendler CB, Glenn JF, Paulson DF. Experience with Gleason histopathologic grading in prostatic cancer . J Urol . 1980;124: 223-225. 15. Paulson DF, Uro-Oncology Research Group. Predictors of lymphatic spread in prostatic adenocarcinoma . J Urol . 1980;123:697-699. 16. Oesterling JE, Brendler CB, Epstein JI, Kimball AW Jr, Walsh PC. Correlation of clinical stage, serum prostatic acid phosphatase and preoperative Gleason grade with final pathological stage in 275 patients with clinically localized adenocarcinoma of the prostate . J Urol . 1987;138:92-98. 17. Zincke H, Farrow GM, Myers RP, Benson RC Jr, Furlow WL, Utz DC. Relationship between grade and stage of adenocarcinoma of the prostate and regional pelvic lymph node metastases . J Urol . 1982;128:498-501. 18. Sagalowsky Al, Milam H, Revely LR, Silva FG. Prediction of lymphatic metastases by Gleason histologic grading in prostate cancer . J Urol . 1982;128:951-952. 19. Badalament RA, O'Toole RV, Young DC, York JP, Drago JR. DNA ploidy and prostate-specific antigen as prognostic factors in clinically resectable prostate cancer . Cancer . 1991;67:3014-3023.Crossref 20. Heller JE. Prostatic acid phosphatase: its current clinical status . J Urol . 1987;137:1091-1103. 21. Catalona WJ, Smith DS, Ratliff TL, et al. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer . N Engl J Med . 1991;324:1156-1161.Crossref 22. Hudson MA, Bahnson RR, Catalona WJ. Clinical use of prostate specific antigen in patients with prostate cancer . J Urol . 1989;142:1011-1017. 23. Lange PH, Ercole CJ, Lightner DJ, Fraley EE, Vessella R. The value of serum prostate specific antigen determination before and after radical prostatectomy . J Urol . 1989;141:873-879. 24. Lange PH. Prostate-specific antigen for staging prior to surgery and for early detection of recurrence after surgery . Urol Clin North Am . 1990;17: 813-817.

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1992

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