Effect Of Pelvic Lymph Node Dissection On Surgical Safety And Postoperative Survival In Patients With Prostate Cancer

The objective:The aim to explore the most suitable pelvic lymph node dissection for prostate cancer patients with different risk grades,by comparing the surgical safety of different pelvic lymph node dissection and its effect on survival time.Methods:78 cases of prostate cancer diagnosed in our hospital was collected from january 2004 to june 2019 which meeting the inclusion criteria,collecting their clinical and pathological data,according to the D’Amico grading criteria,78 patients were divided into low-risk group(14)、middle-risk group(28)and high-risk group(36).age,TNM staging,preoperative PSA and Gleason scores,operation time,blood loss,blood transfusion rate,postoperative hospitalization time,surgical complications,margin-positive rate,total survival time were observed.Follow-up methods include: telephone follow-up,outpatient follow-up,visit and so on.The data were be analyzed,including chi-square test for blood transfusion rate and complication rate,T test for blood loss of operation time and rank sum test for postoperative hospitalization time.The influence of the above data on the long-term survival time of patients were analyzed by some statistical methods,such as Kaplan-Meier survival analysis,multivariate Cox regression analysis and other methods.Results: The average age of all prostate cancer patients was 68.64 years.The number of patients with prostate cancer increased with age,preoperative PSA,and Gleason scores;in the comparison of perioperative data,postoperative complications and pathological results,There was no significant difference in intraoperative blood loss,blood transfusion rate,urinary incontinence rate,wound infection rate,abdominal distention rate,incidence of deep vein thrombosis of lower extremity and positive resection rate in patients with different PLNDs(P>0.05).The intraoperative blood loss was positively correlated with the risk level of the patients(P<0.05).ePLND Compared with sPLND/nPLND-increased lymphatic leakage rate(P <0.05),but it shows high detection rate of positive lymph nodes(P<0.05).The results of log-rank test showed that there was no significant difference in the survival curve of different patients with risk grade,preoperative PSA value,clinical stage,Gleason score,margin positive rate and lymphatic metastasis(P >0.05),The survival curve of the patients in the high-risk group was better than that in the middle-risk group and the low-risk group.Cox multi-factor analysis showed that PLND was a risk factor for the total survival time of patients with prostate cancer.all showed survival advantage(P <0.05),and the survival curve of ePLND was better than that of sPLND in high-risk group,and the difference was statistically significant(P <0.05).Conclusions:1.SPLND showed survival advantage over nPLND in low-and high-risk groups and did not significantly increase perioperative risk in patients with prostate cancer.2.EPLND showed a higher average survival time than sPLND /nPLND in the high-risk group,but it increased the time of operation and the risk of lymphatic leakage.In view of the advantages of ePLND in the diagnosis of lymph node metastasis,ePLND was recommended to improve the survival of patients with prostate cancer in the high-risk group without significant cardiopulmonary function.and it require more data support for the application of ePLND.3.PLND showed a higher survival advantage in patients with different risk levels of prostate cancer,and its positive lymph node dissection rate was also higher,suggesting that PLND improved survival by increasing the clearance of positive lymph nodes in patients.