Application of fluorescent targeted retroperitoneal lymph node dissection in the treatment of lymph node recurrence after radical prostatectomy
10.3760/cma.j.cn112330-20210722-00389
- VernacularTitle:荧光显像腹膜后淋巴结清扫在根治性前列腺切除术后淋巴结复发患者中的应用价值
- Author:
Yu WANG
1
;
Weicong LIANG
;
Zhuolun SUN
;
Jinming DI
;
Xiaopeng LIU
;
Tengcheng LI
;
Ke LI
;
Xingqiao WEN
;
Xin GAO
Author Information
1. 中山大学附属第三医院泌尿外科,广州 510630
- Keywords:
Prostatic neoplasms;
Lymph node recurrence;
Retroperitoneal lymph node dissection;
Fluorescence
- From:
Chinese Journal of Urology
2021;42(9):666-669
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the efficacy of fluorescent retroperitoneal lymph node dissection in the comprehensive treatment of lymph node recurrence after radical prostatectomy (RP).Methods:From January 2017 to December 2020, 25 patients with lymph node recurrence diagnosed by 68Ga-PSMA PET/CT after RP in our hospital were enrolled in this study. The patients were 67 (59-77) years old. The median PSA was 7.7 (0.5-12.6) ng/ml at lymph node recurrence, and was treated with androgen deprivation therapy (ADT), suggesting hormone-sensitive prostate cancer. Before recurrence, 4 cases were in T 2 stage, 17 cases in T 3, 4 cases in T 4, 10 cases in N 0, and 15 cases in N 1stage, 25 cases in M 0stage. 2 cases diagnosed as ISUP grade group <3, 9 cases in group 4, and 14 cases in group 5. The median time from radical resection to recurrence was 43 (27-56) months. All 25 cases were diagnosed as lymph node recurrence by 68Ga-PSMA PET/CT examination. Fluorescence retroperitoneal lymph node dissection was performed. Pelvic lymph nodes were detected in the dark field under the fluorescence mode, and positive lymph nodes were found. The white light mode was switched, and the lymph nodes were cleaned, and recorded. For metastatic lymph nodes indicated by preoperative PSMA PET/CT, routine dissection was performed regardless of whether the lymph nodes were fluorescently positive or not. The only routine examination was performed if there were no lymph nodes with fluorescently positive staining in other sites. Perioperative data, biochemical recurrence (BCR) rate, radiological recurrence (RAR) rate, and follow-up data were collected and analyzed. Results:25 patients were pathologically diagnosed with lymph node metastasis. The median lymph node dissection time was 21(15-28) min, estimated blood loss was 30(20-50) ml, hospital days was 4(3-5)d without any severe complications (