Laparoscopic pelvic lymph node dissection (PLND) for staging prostate cancer in the elderly

The incidence of prostate cancer increases significantly in men as they become elderly. Open pelvic lymph node dissection (PLND) for the staging of prostate cancer has significant morbidity associated with it. Laparoscopic PLND may reduce this morbidity, especially in the elderly male. Thirty-two men, 65 years or older, underwent laparoscopic PLND for prostate cancer staging. The mean age of these patients was 71.3 years (range 65–76), with a mean follow-up of 11.3 months (range 1–23). The mean prostatic specific antigen (PSA) value was 29.1 ng/ml (range 3–113). The mean operative time was 167 minutes (range 75–295). With experience, the operative time fell to 149 minutes. Ninety-one percent of the patients were discharged from hospital within 48 hours. Only 6 minor immediate postoperative complications occurred with no intraoperative or long term postoperative complications occurring. The estimated intraoperative blood loss was ≤100 ml in 97% of the patients. Analgesic use post-operatively was minimal. In conclusion, laparoscopic PLND in the elderly male for prostate cancer staging is an acceptable and safe procedure. We feel it is preferable to the open operation.