リンパ節郭清を中心に

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  • リンパセツカクセイ オ チュウシン ニ

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  A total of 140 patients were treated with robot-assisted laparoscopic prostatectomy（RARP）since August 2009 at our institute. RARP was completed in all cases without conversion to open surgery or allogenic blood transfusion during operation. Our procedure consisted of preservation of endopelvic fascia, lateral approach to bladder neck transection and total pelvic reconstruction of urinary tract. The key is in delicate handling of tissues, reducing trauma, preserving supportive structures, and restoring postoperative anatomy as close as possible to preoperative anatomy. <br>  Pelvic lymph node dissection（PLND）at the time of prostatectomy is an important part of the surgical intervention for prostate cancer and is currently under-reported during robotic procedures. Important questions remain regarding patient selection, potential benefit, anatomic extent of the dissection, nodal yield, and complication rates. Certain literatures have clearly shown that the lymphatic drainage of the prostate is not limited to the obturator and external iliac lymph nodes, and thus a PLND limited to these regions does not address all the potential landing sites. An extended PLND（ePLND）, especially when including the internal and common iliac lymph nodes, more accurately reflects the true lymphatic drainage of the prostate, increases nodal yields and the ability to detect LNI. According to several guidelines, patients with intermediate to high risk prostate cancer should routinely have ePLND performed at the time of radical prostatectomy. Also, it seems safe to exclude PLND in patients undergoing any radical prostatectomy for low-risk prostate cancer. <br>  Robotic PLND for prostate cancer up to the common iliac bifurcation is feasible and increases nodal yield and positive nodal rate. Although extended PLND is recommended to the cases with intermediate to high-risk at RARP, complications associated with PLND should not be neglected.

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