Abstract：
Although several clinical guidelines for prostate cancer (PC) recommend extended pelvic lymph node dissection (ePLND) during radical prostatectomy for high-risk cases, there are several issues to consider, including certain technical aspects. A simplified approach to the medial internal iliac region and paravesical arteries has not been established. The uretero-hypogastric nerve fascia (UHF) envelopes the ureter, hypogastric nerve, and pelvic autonomic nerves. To preserve the UHF, it is possible to approach the medial side of the internal iliac vessels without injuring any important tissue. We analyzed technical feasibility and lymph node (LN) yields.
After obtaining institutional review board approval, 265 high-risk PC patients with ePLND were identified. A da Vinci S or Xi robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used. We divided the patients into conventional (non-UHF) method and modified (UHF) groups. The numbers of LNs removed, procedure-related complications, and surgical outcomes were analyzed.
The median number of LNs removed was 19.0 in the non-UHF group and 22.0 in the UHF group (p = 0.004). Significantly more LNs were removed from the internal iliac region in the UHF group (p = 0.042). There was no difference in overall operative, console, or LN dissection time, or the severe complication rate (Clavien-Dindo grade ≥ III), between the non-UHF and UHF groups.
Our simplified approach using the UHF development technique is technically feasible, has no major complications, and allows for the removal of significantly more LNs compared with the conventional method.
After obtaining institutional review board approval, 265 high-risk PC patients with ePLND were identified. A da Vinci S or Xi robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used. We divided the patients into conventional (non-UHF) method and modified (UHF) groups. The numbers of LNs removed, procedure-related complications, and surgical outcomes were analyzed.
The median number of LNs removed was 19.0 in the non-UHF group and 22.0 in the UHF group (p = 0.004). Significantly more LNs were removed from the internal iliac region in the UHF group (p = 0.042). There was no difference in overall operative, console, or LN dissection time, or the severe complication rate (Clavien-Dindo grade ≥ III), between the non-UHF and UHF groups.
Our simplified approach using the UHF development technique is technically feasible, has no major complications, and allows for the removal of significantly more LNs compared with the conventional method.
摘要：
背景：尽管一些前列腺癌（PC）的临床指南建议在前列腺癌根治术期间对高危病例进行扩大盆腔淋巴结清扫术（ePLND），有几个问题需要考虑，包括某些技术方面。尚未建立简化的内侧髂内区域和旁动脉的方法。输尿管-腹下神经筋膜（UHF）包绕输尿管，腹下神经,和盆腔自主神经.为了保护UHF，可以在不损伤任何重要组织的情况下接近髂内血管的内侧。我们分析了技术可行性和淋巴结（LN）产量。
方法：获得机构审查委员会批准后，确定了265例ePLND高危PC患者。达芬奇S或Xi机器人手术系统(直观手术，桑尼维尔,CA,美国）被使用。我们将患者分为常规（非UHF）和改良（UHF）组。删除的LN的数量，手术相关并发症,并对手术结果进行分析。
结果：在非UHF组中去除LN的中位数为19.0，在UHF组中为22.0（p=0.004）。在UHF组中，明显更多的LN从内部区域去除（p=0.042）。总体手术没有差异，控制台,或LN解剖时间，或严重并发症发生率（Clavien-Dindo等级≥III），在非UHF和UHF组之间。
结论：我们使用UHF开发技术的简化方法在技术上是可行的，没有严重的并发症,与传统方法相比，可以去除更多的LN。
方法：获得机构审查委员会批准后，确定了265例ePLND高危PC患者。达芬奇S或Xi机器人手术系统(直观手术，桑尼维尔,CA,美国）被使用。我们将患者分为常规（非UHF）和改良（UHF）组。删除的LN的数量，手术相关并发症,并对手术结果进行分析。
结果：在非UHF组中去除LN的中位数为19.0，在UHF组中为22.0（p=0.004）。在UHF组中，明显更多的LN从内部区域去除（p=0.042）。总体手术没有差异，控制台,或LN解剖时间，或严重并发症发生率（Clavien-Dindo等级≥III），在非UHF和UHF组之间。
结论：我们使用UHF开发技术的简化方法在技术上是可行的，没有严重的并发症,与传统方法相比，可以去除更多的LN。
