Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 10

27TH CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
04 Extended pelvic lymphadenectomy for prostate
cancer: Results and complications
C Lindberg, M Annerstedt, S Gudjonsson, R Hilmarsson, O Bratt
Department of Urology, University ofLund, Sweden
christian.lindberg@skaiie.se
Aim: The EAU Guidelines no more recommend a pelvic
lymphadenectomy limited to the obturator fossa (L-PLND) for
prostate cancer, but a more extensive one including tissue also
around the external and internal iliac arteries (E-PLND). This
recommendation relies on studies reporting that up to twice
as many patients with metastases can be identified, with only
slightly more complications. However, these studies emanate
from high volume centres. We wanted to investigate whether the
results of those studies could be repeated in a Nordic hospital
with lower patient volume.
Subjects and methods: From 2002 to September 2007 172
patients were operated with radical prostatectomy and PLND at
the University Hospital of Lund, 108 with E-PLND and 64 with
L-PLND.
Results: A median of 17 lymph nodes were identified with
E-PLND but only 7 with L-PLND. In the E-PLND group 10 of
the 22 patients with metastases had such exclusively outside
the obturator fossa. Complications were more common after
E-PLND: time with drain (median 12 vs. 4 days), lymphoceles
(18 vs. 9 %) pulmonary embolism (4.6 vs. 1%) and other
complications (9 vs. 2 %).
Conclusions: Almost half of the patients with metastases are
misclassified by L-PLND. Hence, E-PLND must be performed
if it is important to identify the patients with lymph node
metastases. However, in our hands complications were more
common than reported by high volume centres. This may imply
that E-PLND should be performed by specific high volume
surgeons only.
05 Robot-assisted pelvic lymph node dissection in
prostate cancer
W Soller, T Jiborn, G Ahlgren, P Elfving, A Bjartell
Department ofUrology, Malmoe University Hospital, Malmoe, Sweden
ivolfgang.soller@skane.se
Aim: To report initial results after implementation of robot-
assisted approach as our standard technique for retroperitoneal
pelvic lymph node dissection (RPLND) in patients with newly
diagnosed prostate cancer.
Material and methods: Between Dec 2006 and Dec 2008 we
performed 123 cases of RPLND in patients with prostate cancer,
using the Da Vinci ™ system. Among these patients, 46 were
scheduled for radiotherapy with curative intent and 77 patients
underwent robot-assisted radical prostatectomy simultaneously.
Data were collected prospectively. In the first 79 patients we
removed tissue from the obturator fossa with surrounding
(standard RPLND, SRPLND). From June 2008 (n=34), we used
an extended template also including tissue along the external
iliac vessels, the bifurcation area and the internal iliac artery
(extended RPLND, ERPLND).
Results: Mean operation time was 128 min for SRPLND vs. 134
min for ERPLND and blood loss 44 ml vs. 71 ml. An increased
number of lymph nodes were obtained at ERPLND compared
to SRPLND (mean 25 vs. 20). Lymph node metastases were
detected in 17% of cases. Postoperative complications comprised
lymphocoele with infection (1), thrombosis (1), pulmonary
embolism (1) and ureteral occlusion (1).
Conclusions: Robotic-assisted surgery enables extended RPLND
with short operation time, minimal blood loss, relatively few
complications and a significant increase in number of lymph
nodes harvested.
06 Outcome following open versus robot-assisted
laparoscopic radical prostatectomy
M Borre
Department of Uroiogy, Aarhus University Hospital, Skejby, Denmark
borre@ki.au.dk
Objectives: To evaluate and compare the oncological outcome as
regards surgical margin status and PSA recurrence (PSAR) rates
in patients undergoing the first 100 robot-assisted laparoscopic
radical prostatectomy (RALP) procedures with consecutive
patients treated with open radical prostatectomy (RP) inside the
same period of time.
Patients and materials: Inside 2005 and 2008 the first 100 RALP
procedures took place in Aarhus together with another 172
patients undergoing RP. Data has prospectively been collected
for "the Aarhus PC-project". Median follow-up was 19.5
months.
Results: A preoperative patient selection was observed. The
robotic assisted group thereby had significantly more favorable
preoperatively tumor characteristics. PSAR was demonstrated in
highly statistically significant favor of RALP (p<0.001). Tumour
positive surgical margins (PSM) were observed in 36% and 18%
in RP and RALP respectively (p=0.01), however concerning pT2
tumors about equally often RP and RALP demonstrated tumour
PMS (p=0.3).
Conclusion: RALP demonstrated a highly statistically significant
lower rate of PSAR in the first 100 patients undergoing robotic
assisted approach compared to RP. Despite the encouraging
result long term follow up in homogeneous patients groups is
needed for demonstrating any potential advantage of PALP in
preference to RP.
07 Will robotic radical prostatectomy really do better
than retropubic radical prostatectomy regarding morbidity?
AD Seyer-Hansen, S Skou, M Borre, T Lynnerup, KV Pedersen
Dept ofUrology, Aarhus University Hospital, Skejby, Denmark
bayped@post8. tcle.dk
Aim: Postoperative morbidity after radical prostatectomy
have been claimed to be less after robotic access (ROP) than
after an open procedure (RRP). As shown in our institution,
postoperative incontinence was less after ROP (1). As ROP
10 LÆKNAblaðið 2009/95