Fatih AKKAŞ, Yavuz Onur DANACİOGLU, Mustafa YENİCE, Kamil Gökhan ŞEKER, Selçuk ŞAHİN

Radikal Prostatektomide Eksize Edilen Anterior Prostatik Yağ Dokuda Lenf Nodu Metastazını Predikte Eden Faktörler

Amaç: Açık radikal prostatektomi ve robot yardımlı laparoskopik prostatektomide (RYLP) cerrahi alanın net görülmesi için eksize edilen anterior prostatik yağ dokusunda (APYD) lenf nodu insidansı ve lenf nodu metastazını etkileyen faktörlerin incelenmesi Materyal ve method: Ocak 2018 ve Ocak 2020 arasında tek merkezde RYLP yapılan 219 hastadan eksize edilen APYD lenf nodu varlığı ve lenf nodu metastazı açısından histopatolojik olarak incelendi. Tanımlayıcı istatistikler ve çok değişkenli analiz kullanılarak APYD’da lenf nodu metastazını predikte eden faktörler araştırıldı. Bulgular: APYD’da lenf nodu oranı %9.5 olarak belirlendi. Bu olgular içerisinde 6 olguda (%2.7) lenf nodu metastazı saptandı. 6 olgunun ikisi pelvik lenf nodu diseksiyonu (PLND) yapılmayan düşük ve orta riskli hastaydı. Diğer 4 olgunun ikisinde eş zamanlı olarak pelvik lend nodunda metastaz izlendi. APYD’da metastaz izlenen olgularda toplam tümör volümü, ISUP skoru ve patolojik T evresi tek değişkenli analizde metastaz olmaksızın lenf nodu olanlara göre daha yüksek saptandı. Çok değişkenli analizde ise bu faktörlerin APYD’da lenf nodu metastazını predikte etmediği görüldü. Sonuç: APYD lenf nodu barındırdığı ve mevcut lenf nodlarında metastaz geliştiği kanıtlanan bir dokudur. APYD’da lenf nodu eksizyonunun sadece radikal prostatektomi sırasında cerrahi alanın net görülmesi için uygulanan rutin bir prosedür olmaktan ziyade standart lenf nodu diseksiyonu şablonlarında yer alması gereken bir prosedür olduğu kabul edilmelidir.

Anahtar Kelimeler:

Prostat kanseri, Anterior prostatik yağ doku, Radikal prostatektomi

Predicting Factors for Lymph Node Metastasis in Anterior Prostatic Fat Tissue Excised During Radical Prostatectomy

Background: Examination of the factors affecting lymph node incidence and lymph node metastasis in excised anterior prostatic fat tissue (APFT) in open radical prostatectomy and robot-assisted laparoscopic prostatectomy (RALP) Materials and Methods: Between January 2018 and January 2020, 219 patients who underwent RALP in a single center were examined histopathologically for the presence of lymph node and lymph node metastasis. Factors predicting lymph node metastasis in APFT were investigated using descriptive statistics and multivariate analysis.Results: Lymph node was detected in 21 cases (9.5%) in APYD. Lymph node metastasis was detected in 6 cases (2.7%). Two of the 6 cases were low and moderate risk patients without pelvic lymph node dissection (PLND). In two of the other 4 cases, metastasis was observed simultaneously in the pelvic lend node. In cases where metastasis was observed in APFT, total tumor volume, ISUP score, and pathological T stage were higher in univariate analysis than those with lymph node without metastasis. In multivariate analysis, these factors did not predict lymph node metastasis in APFT.Conclusion: APFT is a tissue that has been proven to contain lymph nodes and metastases. Since APYD excision is a routine procedure applied to see the surgical field clearly during radical prostatectomy, pathological examination of these excised tissues will help make the staging more accurate.

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