Linfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicial
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da PUC_RS |
Texto Completo: | http://tede2.pucrs.br/tede2/handle/tede/10059 |
Resumo: | Introduction: Despite primary treatment of prostate cancer with surgery or external radiation therapy, 20-40% of patients relapse within 5 years and 25-35% progress to metastatic disease. Salvage lymph node dissection has been proposed in patients with biochemical recurrence from prostate cancer and nodal involvement only, although the optimal template remains a question of debate. Herein we describe the technique of robotic extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for "node-only" recurrent prostate cancer and report the initial series. Materials and Methods: Twenty three patients underwent robotic sRPLND+PLND for "node-only" recurrent prostate cancer after definitive primary treatment as identified by PET/CT from September 2015 to December 2016 at Keck Hospital of University of Southern California (USC), Los Angeles, CA, USA. Our anatomic template extends from left renal vein and right renal artery cranially up to Cloquets node caudally, completely excising lymphatic-fatty tissue from aorto-caval and iliac vascular trees. Meticulous node-mapping assessed nodes at 4 prospectively-assigned anatomic zones. Results: Median age at salvage RPLND was 64 years (46-77 years), median BMI was 26.2 kg/m2 (21.7 – 33,8 kg/m2), previous primary treatment was radical prostatectomy in 20 patients (86%) and external radiation therapy in 3 patients (14%), median time from primary treatment was 42 months (1-163 months) and median PSA at sRPLND+PLND was 3.18 ng/mL (0.28 – 32.6 ng/mL). Median operative time was 305 minutes (209-433 minutes), blood loss was 100 ml (25-400 ml), and hospital stay was 1 day (1-6 days). No patient had intra-operative complication, open conversion or blood transfusion. Five patients had Clavien-Dindo Grade I post-operative complications: ileus in 2 patients (8,7%), thigh paresthesia in 1 patient (4,3%) and lymphorrhea in 2 patients (8,7%). Three patients had Clavien-Dindo Grade II complications: flank/scrotal ecchymosis in 1 patient (4,3%), chylous ascites in 1 patients (4,3%) and neuropraxia in 1 patient (4,3%); and 1 patient (4,3%) had lymphocele requiring drainage (IIIa). Final histology confirmed positive nodes in 19 patients (83%). Mean and median (range) number of nodes excised per patient was 84 and 89 (27-132 nodes) respectively. Mean and median (range) number of positive nodes was 24 and 6 (0-109 nodes) respectively. At 2 months post-operatively median (range) PSA was 0.41 ng/mL (0.01-8,3 ng/mL); median decrease of 79% (0-97,5%). In 4 patients the first PSA levels were less than 0,2ng/ml. Conclusion: Herein we describe the detailed technique of robotic high-extended salvage RPLND+PLND for "node-only" recurrent prostate cancer and present the initial experience. Robotic sRPLND+PLND duplicates open surgery, with superior nodal counts and decreased morbidity compared to the published literature. Longer follow-up is necessary to assess oncologic outcomes. |
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Padoin, Alexandre Vontobelhttp://lattes.cnpq.br/0241056171343649http://lattes.cnpq.br/8403022135362890Fay, Carlos Eduardo Schio2022-01-20T19:52:49Z2019-02-28http://tede2.pucrs.br/tede2/handle/tede/10059Introduction: Despite primary treatment of prostate cancer with surgery or external radiation therapy, 20-40% of patients relapse within 5 years and 25-35% progress to metastatic disease. Salvage lymph node dissection has been proposed in patients with biochemical recurrence from prostate cancer and nodal involvement only, although the optimal template remains a question of debate. Herein we describe the technique of robotic extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for "node-only" recurrent prostate cancer and report the initial series. Materials and Methods: Twenty three patients underwent robotic sRPLND+PLND for "node-only" recurrent prostate cancer after definitive primary treatment as identified by PET/CT from September 2015 to December 2016 at Keck Hospital of University of Southern California (USC), Los Angeles, CA, USA. Our anatomic template extends from left renal vein and right renal artery cranially up to Cloquets node caudally, completely excising lymphatic-fatty tissue from aorto-caval and iliac vascular trees. Meticulous node-mapping assessed nodes at 4 prospectively-assigned anatomic zones. Results: Median age at salvage RPLND was 64 years (46-77 years), median BMI was 26.2 kg/m2 (21.7 – 33,8 kg/m2), previous primary treatment was radical prostatectomy in 20 patients (86%) and external radiation therapy in 3 patients (14%), median time from primary treatment was 42 months (1-163 months) and median PSA at sRPLND+PLND was 3.18 ng/mL (0.28 – 32.6 ng/mL). Median operative time was 305 minutes (209-433 minutes), blood loss was 100 ml (25-400 ml), and hospital stay was 1 day (1-6 days). No patient had intra-operative complication, open conversion or blood transfusion. Five patients had Clavien-Dindo Grade I post-operative complications: ileus in 2 patients (8,7%), thigh paresthesia in 1 patient (4,3%) and lymphorrhea in 2 patients (8,7%). Three patients had Clavien-Dindo Grade II complications: flank/scrotal ecchymosis in 1 patient (4,3%), chylous ascites in 1 patients (4,3%) and neuropraxia in 1 patient (4,3%); and 1 patient (4,3%) had lymphocele requiring drainage (IIIa). Final histology confirmed positive nodes in 19 patients (83%). Mean and median (range) number of nodes excised per patient was 84 and 89 (27-132 nodes) respectively. Mean and median (range) number of positive nodes was 24 and 6 (0-109 nodes) respectively. At 2 months post-operatively median (range) PSA was 0.41 ng/mL (0.01-8,3 ng/mL); median decrease of 79% (0-97,5%). In 4 patients the first PSA levels were less than 0,2ng/ml. Conclusion: Herein we describe the detailed technique of robotic high-extended salvage RPLND+PLND for "node-only" recurrent prostate cancer and present the initial experience. Robotic sRPLND+PLND duplicates open surgery, with superior nodal counts and decreased morbidity compared to the published literature. Longer follow-up is necessary to assess oncologic outcomes.Introdução: Apesar do tratamento inicial do câncer de próstata na doença clinicamente localizada com cirurgia ou radioterapia externa, entre 20 a 40% dos pacientes irão apresentar recidiva em 5 ano e entre 25 a 35% dos pacientes progredirão para doença metastática. Linfadenectomia de salvamento tem sido proposta em pacientes com recidiva bioquímica do câncer de próstata e acometimento linfonodal apenas, embora o nivel de dissecção permaneça em debate. Neste trabalho descrevemos a técnica de linfadenectomia estendida retroperitoneal e pélvica robótica de salvamento para câncer de próstata recorrente e reportamos a série inicial Materiais e Métodos: Um total de 23 pacientes com recidiva bioquímica e doença linfonodal pelo PET/CT foram submetidos prospectivamente a linfadenectomia robótica estendida retroperitoneal e pélvica de salvamento no período de setembro de 2015 a dezembro de 2016 no Keck Hospital da University of Southern California (USC), Los Angeles, CA, EUA. O nível de ressecção estende-se cranialmente da veia renal esquerda e artéria renal direita até o linfonodo de Cloquet caudalmente, excisando completamente o tecido linfático-adiposo ao longo da aorta, cava e vasos ilíacos. Resultados: Idade mediana na linfadenectomia foi 64 anos (46-77 anos), IMC mediano foi de 26.2 kg/m2 (21.7 – 33,8 kg/m2), tratamento primário prévio foi prostatectomia radical em 20 pacientes (86%) e radioterapia externa em 3 pacientes (14%), tempo do tratamento primário até a linfadenectomia foi de 42 meses (1-163 meses) e PSA foi de 3,18 ng/ml (0.28 – 32,6 ng/ml). Tempo operatório mediano foi de 305 minutos (209-433 minutos), sangramento foi de 100 ml (25-400 ml) e tempo de hospitalização de 1 dia (1-6 dias). Não houve complicação intra-operatória, conversão para cirurgia aberta ou transfusão sanguínea. Cinco pacientes apresentaram complicações Clavien-Dindo Grau I no pós operatório: íleo em 2 pacientes (8,7%), parestesia na coxa em 1 paciente (4,3%) e linforréia em 2 pacientes (8,7%). Três pacientes desenvolveram complicações Clavien-Dindo Grau II: equimose do flanco e bolsa escrotal em 1 paciente (4,3%), ascite quilosa em 1 paciente (4,3%) e neuropraxia em 1 paciente (4,3%); e 1 paciente (4,3%) necessitou drenagem de linfocele (IIIa). A análise histológica confirmou metástase linfonodal em 19 pacientes (83%). O número de linfonodos médios e medianos (intervalo) por paciente foram 84 e 89 (27-132 linfonodos) respectivamente. O número de linfonodos médios e medianos (intervalo) por paciente foram 24 e 6 (0-109 linfonodos) respectivamente. Aos dois meses de pós operatório, o PSA mediano foi de 0,41 ng/ml (0.01 – 8,3 ng/ml); houve redução média de 79% (intervalo de 0 a 97,5%). Em 4 pacientes o primeiro PSA no pós operatório foi menor de 0,2 ng/ml. Conclusões: A linfadenectomia estendida retroperitoneal e pélvica robótica de salvamento replica a cirurgia aberta, com maior número de linfonodos e morbidade diminuída comparada com a literatura. Neste trabalho descrevemos a técnica e reportamos a série inicial. Maior acompanhamento a longo prazo é necessário para a avaliação dos desfechos oncológicos.Submitted by PPG Medicina e Ciências da Saúde (medicina-pg@pucrs.br) on 2022-01-19T19:31:53Z No. of bitstreams: 1 tese final doutorado Carlos Eduardo Schio Fay_.pdf: 6020320 bytes, checksum: efce1f970d93c7faa21b987d1d57ea6b (MD5)Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2022-01-20T19:46:26Z (GMT) No. of bitstreams: 1 tese final doutorado Carlos Eduardo Schio Fay_.pdf: 6020320 bytes, checksum: efce1f970d93c7faa21b987d1d57ea6b (MD5)Made available in DSpace on 2022-01-20T19:52:49Z (GMT). No. of bitstreams: 1 tese final doutorado Carlos Eduardo Schio Fay_.pdf: 6020320 bytes, checksum: efce1f970d93c7faa21b987d1d57ea6b (MD5) Previous issue date: 2019-02-28Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESapplication/pdfhttp://tede2.pucrs.br:80/tede2/retrieve/183125/TES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdf.jpgporPontifícia Universidade Católica do Rio Grande do SulPrograma de Pós-Graduação em Medicina e Ciências da SaúdePUCRSBrasilEscola de MedicinaCâncer de PróstataRecorrência BioquímicaLinfadenectomia de Salvamento Cirurgia RobóticaProstate CancerBiochemical RecurrenceSalvage Lymph Node DissectionRobotic SurgeryCIENCIAS DA SAUDE::MEDICINALinfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicialinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisTrabalho será publicado como artigo ou livro60 meses20/01/2027-721401722658532398500500500600-224747486637135387-9693694523087866273590462550136975366info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_RSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSTHUMBNAILTES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdf.jpgTES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdf.jpgimage/jpeg4083http://tede2.pucrs.br/tede2/bitstream/tede/10059/4/TES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdf.jpga1ad0730a1681083da8f7dc90b4f65fcMD54TEXTTES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdf.txtTES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdf.txttext/plain1317http://tede2.pucrs.br/tede2/bitstream/tede/10059/3/TES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdf.txt39627f6965f146bc15e5d98c0938a7e4MD53ORIGINALTES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdfTES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdfapplication/pdf547574http://tede2.pucrs.br/tede2/bitstream/tede/10059/2/TES_CARLOS_EDUARDO_SCHIO_FAY_CONFIDENCIAL.pdf10b19ab1855311dc91f86823d0c54e3cMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-8590http://tede2.pucrs.br/tede2/bitstream/tede/10059/1/license.txt220e11f2d3ba5354f917c7035aadef24MD51tede/100592022-01-20 20:00:39.463oai:tede2.pucrs.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://tede2.pucrs.br/tede2/PRIhttps://tede2.pucrs.br/oai/requestbiblioteca.central@pucrs.br||opendoar:2022-01-20T22:00:39Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
dc.title.por.fl_str_mv |
Linfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicial |
title |
Linfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicial |
spellingShingle |
Linfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicial Fay, Carlos Eduardo Schio Câncer de Próstata Recorrência Bioquímica Linfadenectomia de Salvamento Cirurgia Robótica Prostate Cancer Biochemical Recurrence Salvage Lymph Node Dissection Robotic Surgery CIENCIAS DA SAUDE::MEDICINA |
title_short |
Linfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicial |
title_full |
Linfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicial |
title_fullStr |
Linfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicial |
title_full_unstemmed |
Linfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicial |
title_sort |
Linfadenectomia robótica retroperitoneal e pélvica de salvamento no câncer de próstata com recidiva linfonodal : técnica e série inicial |
author |
Fay, Carlos Eduardo Schio |
author_facet |
Fay, Carlos Eduardo Schio |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Padoin, Alexandre Vontobel |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/0241056171343649 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/8403022135362890 |
dc.contributor.author.fl_str_mv |
Fay, Carlos Eduardo Schio |
contributor_str_mv |
Padoin, Alexandre Vontobel |
dc.subject.por.fl_str_mv |
Câncer de Próstata Recorrência Bioquímica Linfadenectomia de Salvamento Cirurgia Robótica |
topic |
Câncer de Próstata Recorrência Bioquímica Linfadenectomia de Salvamento Cirurgia Robótica Prostate Cancer Biochemical Recurrence Salvage Lymph Node Dissection Robotic Surgery CIENCIAS DA SAUDE::MEDICINA |
dc.subject.eng.fl_str_mv |
Prostate Cancer Biochemical Recurrence Salvage Lymph Node Dissection Robotic Surgery |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA |
description |
Introduction: Despite primary treatment of prostate cancer with surgery or external radiation therapy, 20-40% of patients relapse within 5 years and 25-35% progress to metastatic disease. Salvage lymph node dissection has been proposed in patients with biochemical recurrence from prostate cancer and nodal involvement only, although the optimal template remains a question of debate. Herein we describe the technique of robotic extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for "node-only" recurrent prostate cancer and report the initial series. Materials and Methods: Twenty three patients underwent robotic sRPLND+PLND for "node-only" recurrent prostate cancer after definitive primary treatment as identified by PET/CT from September 2015 to December 2016 at Keck Hospital of University of Southern California (USC), Los Angeles, CA, USA. Our anatomic template extends from left renal vein and right renal artery cranially up to Cloquets node caudally, completely excising lymphatic-fatty tissue from aorto-caval and iliac vascular trees. Meticulous node-mapping assessed nodes at 4 prospectively-assigned anatomic zones. Results: Median age at salvage RPLND was 64 years (46-77 years), median BMI was 26.2 kg/m2 (21.7 – 33,8 kg/m2), previous primary treatment was radical prostatectomy in 20 patients (86%) and external radiation therapy in 3 patients (14%), median time from primary treatment was 42 months (1-163 months) and median PSA at sRPLND+PLND was 3.18 ng/mL (0.28 – 32.6 ng/mL). Median operative time was 305 minutes (209-433 minutes), blood loss was 100 ml (25-400 ml), and hospital stay was 1 day (1-6 days). No patient had intra-operative complication, open conversion or blood transfusion. Five patients had Clavien-Dindo Grade I post-operative complications: ileus in 2 patients (8,7%), thigh paresthesia in 1 patient (4,3%) and lymphorrhea in 2 patients (8,7%). Three patients had Clavien-Dindo Grade II complications: flank/scrotal ecchymosis in 1 patient (4,3%), chylous ascites in 1 patients (4,3%) and neuropraxia in 1 patient (4,3%); and 1 patient (4,3%) had lymphocele requiring drainage (IIIa). Final histology confirmed positive nodes in 19 patients (83%). Mean and median (range) number of nodes excised per patient was 84 and 89 (27-132 nodes) respectively. Mean and median (range) number of positive nodes was 24 and 6 (0-109 nodes) respectively. At 2 months post-operatively median (range) PSA was 0.41 ng/mL (0.01-8,3 ng/mL); median decrease of 79% (0-97,5%). In 4 patients the first PSA levels were less than 0,2ng/ml. Conclusion: Herein we describe the detailed technique of robotic high-extended salvage RPLND+PLND for "node-only" recurrent prostate cancer and present the initial experience. Robotic sRPLND+PLND duplicates open surgery, with superior nodal counts and decreased morbidity compared to the published literature. Longer follow-up is necessary to assess oncologic outcomes. |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019-02-28 |
dc.date.accessioned.fl_str_mv |
2022-01-20T19:52:49Z |
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http://tede2.pucrs.br/tede2/handle/tede/10059 |
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por |
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Pontifícia Universidade Católica do Rio Grande do Sul |
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Programa de Pós-Graduação em Medicina e Ciências da Saúde |
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PUCRS |
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Pontifícia Universidade Católica do Rio Grande do Sul |
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