67th Annual Meeting Abstracts

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Pelvic Lymph Node Dissection is Associated with Venous Thrombo-embolism Risk during Laparoscopic Radical Prostatectomy
*John B Eifler, Jr., *Adam W Levinson, Patrick C Walsh, Christian P Pavlovich
Brady Urological Institute, Baltimore, MD

Introduction:Venous thrombo-embolism (VTE) is a source of serious morbidity and mortality after radical prostatectomy (RP). It is unknown whether pelvic lymph node dissection (PLND) is related to the development of VTE. Given that PLND may not be necessary in most contemporary surgical patients, we wondered whether omitting PLND might decrease the incidence of VTE.
Materials & Methods: The records of 698 consecutive men who underwent laparoscopic radical prostatectomy (LRP) by a single surgeon between 2001 and 2007 were reviewed for postoperative VTE. All had at least 3 months of follow-up. All patients underwent transperitoneal or extraperitoneal LRP +/- laparoscopic PLND. Only those at increased risk for lymph node metastasis by Partin nomogram and those who requested PLND received simultaneous limited pelvic lymphadenectomy.
Results:417 patients (60.1%) received LRP+PLND; 281 received LRP only (39.9%). VTE occurred in 6/417 LRP+PLND patients (1.4%), and in 0/281 LRP only patients (0%) (p =0.046). Patients who underwent LRP+PLND and developed VTE had significantly greater BMI (31.0 vs. 27.0, p<0.05), higher lymph node counts (6.5 vs. 5.7, p=n.s.) and longer operative times (3.9 vs. 3.3hrs, p=n.s.) than those who underwent LRP+PLND who did not develop VTE. Only 3/417 (0.7%) LRP+PLND patients had positive lymph nodes.
Conclusions:PLND may increase the risk of VTE without providing a cancer control benefit in most patients undergoing RP for clinically localized prostate cancer. Our data argue that lymphadenectomy should be judiciously rather than routinely performed for patients at low risk for LN metastasis.

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