Open pelvic lymph node dissection for XXXX : a reassessment.

@entity1 @entity263 @entity5 @entity3 @entity1486
OBJECTIVES: To provide a risk-to-benefit analysis of open staging pelvic lymph node dissection (PLND) for @entity263 . METHODS: The medical records of all @entity1 presenting with @entity263 from July 1989 to April 1994 were reviewed. A total of 245 @entity1 with clinically localized disease were selected to undergo radical retropubic prostatectomy (RRP) preceded by open PLND. Univariate and multivariate analyses were performed to evaluate the predictive value of the preoperative serum @entity1486 concentration, clinical stage, and Gleason score with regard to final nodal status. The cost and morbidity associated with PLND in the setting of RRP was also defined. RESULTS: Overall, only 16 @entity1 (6.5%) had lymph node @entity3 . Lymph node involvement correlated significantly with elevated serum @entity1486 values (P = 0.0001), high Gleason score (P = 0.0022), and advanced clinical stage (P = 0.0001). Lymph node @entity3 were particularly uncommon in @entity1 with nonpalpable @entity5 (1 of 67 [1.5%]), @entity1486 values less than 10 (2 of 154 [1.3%]), and Gleason score less than 6 (1 of 26 [3.8%]). Overall, 179 @entity1 (73.1%) presented with at least one or more of these favorable characteristics, and only 4 (2.2%) had lymph node involvement. Complications related to the lymphadenectomy occurred in 10 @entity1 (4.1%). The cost per @entity3 diagnosed in @entity1 with low-risk characteristics was approximatley  43,600. CONCLUSIONS: An open staging PLND may no longer be justified on a routine basis in @entity1 undergoing radical retropubic prostatectomy.
