Pelvic lymphadenectomy in the management of carcinoma of the prostate.

Between January 1, 1971 and December 30, 1977, 82 patients underwent bilateral pelvic lymph-adenectomy for carcinoma of the prostate, 65 with associated radical prostatectomy. Lymph node metastases were noted in 27 cases: 1 of 8 with A2, 3 of 16 with B1, 12 of 39 with B2 and 11 of 19 with C tumors. Of the 17 patients undergoing lymphadenectomy only as a staging procedure before definitive radiation therapy 12 had nodal involvement, while 15 of 64 patients with combined lymphadenectomy and prostatectomy had nodal disease. Early complications involved 6 patients with thromboembolic disease, including 1 death while the patient was hospitalized of pulmonary embolism. All 6 thromboembolic complications occurred among 52 patients who had not received anticoagulation, for an incidence of 11.5 per cent compared to no episode of thromboembolism among 30 patients prophylactically anticoagulated with warfarin sodium. Late complications of chronic lymphedema occurred in 15 patients, 10 of whom had postoperative radiation. We recommend lymphadenectomy as an adjunct to radical prostatectomy but its role as a staging procedure before definitive radiation therapy to the pelvis appears to yield increased morbidity in terms of incidence of chronic lymphedema, suggesting that its use be reserved for highly selected patients. We also recommend the prophylactic postoperative administration of anticoagulants and patients awareness of risk factors contributing to chronic lymphedema.