限局性前立腺癌に対する腹腔鏡下骨盤内リンパ節郭清術の意義

Abstract

Stage B, Cの限局性前立腺癌50例に対し,腹腔鏡下骨盤内リンパ節郭清を施行した. 1)後腹膜的到達法は経腹的操作に比較して合併症は少なく,出血量の有意な減少,手術時間の短縮がみられ,minimally invasive surgeryとして優れた術式といえる. 2)両側の骨盤内リンパ節郭清を行えた48例のうちリンパ節転移は19例に認められたが,術中凍結切片による迅速病理検査では7例がfalse negativeであった. 3)Stage C,低分化癌以外にstage B,高分化,中分化癌のうちPSADが0.5ng/ml/ml以上の症例ではリンパ節転移の可能性が高いと考えられた We report the clinical results and efficacy of laparoscopic pelvic lymphadenectomy for localized prostate cancer. This procedure was followed by radical prostatectomy, when metastasis was not found in the frozen section, and by optional treatment, such as transurethral resection (TUR) or castration, other than radical prostatectomy when metastasized nodes were found. We performed transperitoneal laparoscopic lymphadenectomy on 30 patients and extraperitoneal approach on 20 between April, 1992 and September, 1995. The patients were between 52 and 78 years old. Nineteen, patients had stage B1, 17 stage B2 and 14 stage C cancer. Bilateral obturator nodes were dissected. We could not perform laparoscopic lymphadenectomy on two patients because of adhesion. The average operation time and blood loss were 166 minutes and 151 ml, respectively, in the transperitoneal group, while 142 minutes and 126 ml in the extraperitoneal group. The average number of removed nodes was 12 in the transperitoneal group and 10 in the extraperitoneal group. The extraperitoneal approach is a safer and useful procedure. Nodal metastasis were found in 12 patients by frozen section. Additional positive nodes were found in 7 patients by a further study. Two were not harvested laparoscopically and 5 were ascertained only by permanent section. Therefore, the two-staged operation might be preferable. Nodal metastasis was likely to be found in localized prostate cancer patients with clinical stage C, poorly differentiated cancer, or prostatic specific antigen density (PSAD) over 0.5 ng/ml/ml. Laparoscopic pelvic lymphadenectomy might be indicated for these cases.