Akademik Veri Yönetim Sistemi
WCE 2022, California, Amerika Birleşik Devletleri, 1 - 04 Ekim 2022, ss.305
Introduction & Objective: Robot-assisted radical prostatectomy and lymph node dissection is an essential step for the
treatment of prostate cancer. Lymph node dissection in high-risk
patients are recommended in guidelines. Appropriate staging and
survival advantage may provided with appropriate lymph node
dissection. Today, Ga68 PSMA PET is frequently used for lymph
node staging. In order to find and remove suspicious lymph
nodes, marking can be done with Tc99m at the preoperative
period, especially for the nodes that are not in standard dissection
template. In this video, we share our experiences with our 2
patients.
Methods: First case: 58-year-old patient with a PSA value of
9.5 ng/ml had undergone prostate biopsy for PIRADS 5 lesion
detected in mpMRI. Gleason 9 (4 + 5) adenocancer reported.
Suspicious lymph nodes were detected in the left obturator fossa
and anterior of the bladder with Ga68 PSMA PET. These lymph
nodes were labeled with Tc99m macro aggregated albumin
(MAA). During the surgery, after their excision of these nodes,
they were checked with gamma probe and confirmed for radionuclide presence Frozen examination of these nodes showed
adenocarcinoma metastasis. Second case: 69-year-old patient
with a PSA value of 24 ng/ml underwent prostate biopsy for a
PIRADS 5 lesion at mpMRI. A Gleason 7 (4 + 3) adenocancer
was detected. A pathological lymph node was detected in the
right obturator fossa with Ga68 PSMA PET scan. This lymph
node was labeled with MAA. Excised lymph node checked with
gamma probe and confirmed for radionuclide presence . Likewise, frozen section analysis of the excised lymph node confirmed metastasis.
Results: Final pathology analysis of both excised lymph nodes
was found to be compatible with metastasis.
Conclusions: Radio-guided surgery can ease excision of metastatic lymph nodes located outside the standard lymphadenomectomy templates.