Standardna u odnosu na proširenu karličnu limfadenektomiju kod bolesnika sa klinički lokalizovanim karcinomom prostate
Sažetak
Apstrakt
Uvod/Cilj. Karlična limfadenektomija predstavlja najprecizniju proceduru u dijagnostici metastaza karcinoma prostate u limfne čvorove. Međutim, njena terapijska vrednost još uvek nije jasna. Cilj ove studije je bio da uporedi dijagnostičku i terapijsku vrednost proširene i standardne karlične limfadenektomije u sklopu radikalne prostatektomije. Metode. Ukupno 157 bolesnika koji su hirurški lečeni radi klinički lokalizovanog raka prostate bili su uključeni u otvorenu nerandomizovanu prospektivnu studiju. U grupu standardne karlične limfadenektomije (sPLND) bilo je uključeno 109 bolesnika, a u grupu proširene karlične limfadenektomije (ePLND) 48 bolesnika. Obe grupe su bile upoređene prema starosti, koncentraciji prostate specifičnog antigena (PSA), procentu pozitivnih bioptata, Gleason skoru, broju odstranjenih i pozitivnih limfnih čvorova, trajanju operacije, procenjenoj količini gubitka krvi, količini limforeje i preživljavanju bez biohemijskog recidiva. Rezultati. Prosečan broj odstranjenih limfnih čvorova bio je 17,3 u sPLND grupi i 24,5 u ePLND grupi (p = 0.001). U sPLND grupi 9/109 (8,3%) bolesnika imalo je pozitivne limfne čvorove, a u ePLND grupi 8/48 (16,7%). Biohemijski recidiv ustanovljen je kod 31/109 (31,2%) bolesnika u sPLND grupi odnosno 7/48 (14,6%) bolesnika u ePLND grupi (p = 0.003). Zaključak. Upoređivanje sPLND i ePLND grupa dovelo je do sledećih zaključaka: proširenom karličnom limfadenektomijom se odstrani značajno više limfnih čvorova; prošenom karličnom limfadenektomijom dijagnostikuje se mnogo više metastaza u limfnim čvorovima; značajno je povoljnije preživljavanje bez biohemijskog recidiva u grupi proširene karlične limfadenektomije.
Reference
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