LAPAROSCOPIC RADICAL PROSTATECTOMY FOR HIGH RISK LOCALIZED AND LOCALLY ADVANCED DISEASE
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MARCOS TOBIAS-MACHADO, EDUARDO S. STARLING, ALEXANDRE STIEVANO CARLOS, ANTONIO C. L. POMPEO, PEDRO ROMANELLI, RICARDO NISHIMOTO

Department of Urology, ABC Medical School, Santo André (MTM, ESS, ASC, ACLP), SP, Brazil and Minas Gerais Military Hospital, Belo Horizonte (PR, RN), MG, Brazil

ABSTRACT

Background: Penile cancer is a rare disease, most commonly encountered in developing countries. It constitutes 0.4% of cancers in U.S. men and 2.1% in Brazil, with the highest prevalence in the North and Northeast regions. Inguinal lymph node metastasis of penile cancer occurs in 20 to 40% of patients and is an important predictor of cancer-specific mortality. The preferred diagnostic and therapeutic tool to assess the regional lymph nodes is a lymphadenectomy which can, in addition to establishing staging, offers curative potential.
Materials and Methods: A 44 years old man, previously u to underwent a partial penectomy for penile cancer, whose pathology showed a moderately differentiated squamous cell carcinoma with neural and angiolymphatic invasion and negative surgical margins. The pathologic stage of the primary tumor was pT3NxMx. Following a one month course of oral antibiotics, the patient underwent a video-assisted bilateral inguinal lymphadenectomy. In the present video, we highlight the left video-assisted inguinal lymphadenectomy.
Results: Seventeen lymph nodes were dissected on the left side, two of them positive for cancer without extracapsular extension. On the right side, fourteen lymph nodes were dissected and one was positive for cancer with extracapsular extension, and the patient underwent based on these pathological findings a pelvic lymphadenectomy, which was similarly conducted using a video-assisted laparoscopic approach.
Conclusions: The conventional open lymphadenectomy has a morbidity that can approach 50% in the current series, despite on the refinements in technique. The video-assisted endoscopy is a recent technique aiming to decrease this inherent complication rate promoting a lymph node resection rate which may be equivalent to the open procedure. This video confirms its feasibility, reduced morbidity, and cancer control efficacy.

ARTICLE INFO

Int Braz J Urol. 2012; 38 (Video #3): 430-431
Available at: www.brazjurol.com.br/videos/may_june_2012/Tobias-Machado_430_431video.htm

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Submitted for publication:
February 15, 2012

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Accepted after revision:
May 12, 2012

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Correspondence address:
Dr. Alexandre Stievano Carlos
Rua Cantagalo 612 / 61
Sao Paulo, SP, Brazil
Fax: + 55 11 2093-7434
E-mail: ale_carlos@uol.com.br

Editoral Comment

            The authors describe and then demonstrate the technique of pure laparoscopic radical prostatectomy and extended pelvic lymph node dissection in a patient with high risk prostate cancer. They appropriately comment that surgery is able to achieve reasonable cancer control in this challenging group of patients with aggressive cancers. They clearly address the two main surgical principles that allow optimizing the procedure: Wide excision of the neurovascular bundles and bladder neck and the completion of an extended lymph node dissection. The video demonstrates the gross appearance of an adequately performed lymph node dissection on the left side with clear anatomical definition of the distal common iliac vessels, full mobilization of the external iliac artery and vein and a clean obturator fossa. More importantly, they demonstrate that the procedure may be performed safely and efficiently through a pure laparoscopic approach in centers with surgeons experienced in advanced laparoscopy and without the need of the robot. This is of relevance as many centers in Latin America currently do not have access to robotic technology.

Dr. Julio Pow-Sang
Moffitt Cancer Center
Tampa, Florida, USA
E-mail: julio.powsang@moffitt.org