Radical perineal prostatectomy and simultaneous extended pelvic lymph node dissection via the same incision

Objectiues: Assess the feasibility of extended bilateral pelvic lymph node dissection (ePLND) in radical perineal prostatectomy (RPP) via the same incision under direct vision. Methods: In 90 consecutive patients with prostate cancer and a prostate-specific antigen level >10 ng/ml or a Gleason score >5 or more than two positive biopsies, RPP and ePLND via the same incision were performed in a prospective trial. After removing the prostate, the endopelvic fascia was opened with scissors and the bladder pushed medially. We performed an extended dissection along the obturator nerve, the external iliac vessels up to the ureter and along the internal iliac artery. Complications, number of nodes removed, and number of patients with tumour-positive nodes were recorded. Recovery of urinary continence and erectile function were assessed by a patient-reported questionnaire and the International Index of Erectile Function 5 questionnaire, respectively, administered preoperatively and at 1, 3, 6, and 12 mo. Results: We removed a mean and median number of 19 and 18.7 lymph nodes, respectively. Twelve patients had lymph node metastasis. Mean operation time was 149 min, including the complete learning curves of three surgeons. Seven lymphoceles but no major complications occurred. After 1, 3, 6, and 12 mo, 32 (36%), 50 (56%), 74 (82%), and 84 (93%) patients were completely dry, using no pads. Conclusion: ePLND and RPP under direct vision via the same incision are feasible, efficient, and associated with a fast recovery of urinary continence and a low complication rate. Because lymphadenectomy needs no second access, the major disadvantage of RPP is resolved. (C) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.