Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press78810.17650/1726-9776-2018-14-3-51-57DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. PROSTATE CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак предстательной железыROBOT-ASSISTED PELVIC LYMPH NODE DISSECTION USING ICG TESTING IN PATIENTS WITH PROSTATE CANCERРОБОТ-АССИСТИРОВАННАЯ ТАЗОВАЯ ЛИМФАДЕНЭКТОМИЯ С ИСПОЛЬЗОВАНИЕМ ICG-ДИАГНОСТИКИ У ПАЦИЕНТОВ С РАКОМ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫAboyanI. A.АбоянИ. А.
Russian Federation

70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011.

344011 Ростов-на-Дону, пер. Доломановский, 70/3.

PakusD. I.ПакусД. И.
Russian Federation

70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011.

344011 Ростов-на-Дону, пер. Доломановский, 70/3.

PakusS. M.ПакусС. М.

70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011.

Пакус Сергей Михайлович - врач-уролог. кандидат медицинских наук.  

344011 Ростов-на-Дону, пер. Доломановский, 70/3.

sergejj.pakus@rambler.ruGrachevS. V.ГрачевС. В.

70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011.

344011 Ростов-на-Дону, пер. Доломановский, 70/3.

BerezinK. V.БерезинК. В.

70/3 Dolomanovskiy Pereulok, Rostov-on-Don 344011.

344011 Ростов-на-Дону, пер. Доломановский, 70/3.

“Health” Clinical and Diagnostic Center of Rostov-on-DonМБУЗ «Клинико-диагностический центр «Здоровье» города Ростова-на-Дону»3009201814351571002201803052018https://oncourology.abvpress.ru/oncur/article/view/788

The objective is to investigate the possibility of using fluorescent testing in robot-assisted radical prostatectomy using indocyanine green (ICG testing) during pelvic lymph node dissection (PLND) in patients with localized prostate cancer.

Materials and methods. Fifteen minutes prior to robot-assisted PLND, intraprostatic transperineal administration of 0.4 ml of indocyanine green (ICG) per lobe under transrectal ultrasound control was performed. Fluorescence map was used. After activation of the FireFly mode, fluorescence of the lymph nodes was evaluated. If a sentinel lymph node was present, lymph node dissection was performed using the FireFly mode. If fluorescence was diffuse, PLND using this option wasn’t performed.

Results. In total, 35 patients with localized prostate cancer underwent surgery. Mean age was 62.0 ± 6.5 years (41–68 years), mean prostatespecific antigen level prior to surgery was 15.6 ± 11.3 ng/ml (1.5–27.0 ng/ml).  Postoperative examination revealed micrometastases in the lymph nodes in 7 (20 %) cases. Sentinel lymph nodes were detected in 29 patients. Intraoperative examination revealed sentinel lymph nodes metastases in 6 (17 %) cases, in other cases (83 %) metastases were absent. Morphological examination showed that in 5 (83 %) of 6 patients with lesions in the sentinel lymph node, micrometastases in other lymph nodes were present. In patients without lesions in the sentinel lymph node, no micrometastases in other lymph nodes were observed. PLND complications included lymphocele in 3 (8 %) patients, prolonged drain indwelling time in 5 (14 %) patients.

Conclusion. Initial experience of our clinic shows reproducibility and low complications profile of fluorescence monitoring in the near-infrared region using ICG testing during robot-assisted PNLD. In conditions of continuous increase in the number of performed robot-assisted radical prostatectomies, ICG testing is a promising minimally invasive method for evaluation of regional metastases allowing to detect the sentinel lymph node. This approach allows to decrease the number of complications associated with PLND.

Цель исследования – изучение возможности применения флуоресцентного исследования при робот-ассистированной радикальной простатэктомии с использованием индоцианина зеленого (ICG-диагностики) во время тазовой лимфаденэктомии (ТЛАЭ) у пациентов с локализованным раком предстательной железы.

Материалы и методы. Перед выполнением робот-ассистированной ТЛАЭ было проведено интрапростатическое трансперинеальное введение индоцианина зеленого (ICG) под трансректальным ультразвуковым контролем в количестве 0,4 мл в каждую долю за 15 мин до начала оперативного вмешательства. Использовали карту флуоресценции. После активации режима FireFly проводили оценку флуоресценции лимфатических узлов. При наличии «сигнального» лимфатического узла выполняли лимфаденэктомию с использованием режима FireFly. В случае диффузного характера флуоресценции ТЛАЭ с применением данной опции не проводилось.

Результаты. Были прооперированы 35 пациентов с локализованным раком предстательной железы. Средний возраст составил 62,0± 6,5 года (41–68 лет), средний уровень простатического специфического антигена до операции – 15,6 ± 11,3 нг/мл (1,5–27,0 нг/мл). При послеоперационном исследовании в 7 (20 %) случаях выявлены микрометастазы в лимфатических узлах. «Сигнальные» лимфатические узлы обнаружены у 29 пациентов. При интраоперационном исследовании в 6 (17 %) случаях выявлены метастазы в «сигнальном» лимфатическом узле, в остальных (83 %) случаях метастазы отсутствовали. При морфологическом исследовании у 5 (83 %) из 6 пациентов с поражением «сигнального» лимфатического узла обнаружены микрометастазы в других лимфатических узлах. У пациентов с отсутствием поражения «сигнального» лимфатического узла не выявлено микрометастазов в других лимфатических узлах. Осложнения ТЛАЭ включали лимфоцеле у 3 (8 %) больных, длительное сохранение отделяемого по дренажам у 5 (14 %).

Заключение. Инициальный опыт нашей клиники показывает воспроизводимость и низкий профиль осложнений флуоресцентного мониторинга в ближней инфракрасной области спектра с использованием ICG-диагностики при выполнении робот-ассистированной ТЛАЭ. В условиях непрерывного увеличения количества выполняемых робот-ассистированных радикальных простатэктомий ICG-диагностика является перспективным минимально-инвазивным методом оценки регионарного метастазирования, позволяющим выявить «сигнальный» лимфатический узел. Данный подход позволяет снизить количество осложнений, связанных с ТЛАЭ.

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