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Radical prostatectomy is the best treatment for patients with T1-2 prostate cancer and a life expectancy of over 10 years, but no pN1 patient that underwent only surgery, was progression free at 10 years (Partin 1994). In the last 10 years we performed 441 consecutive pelvic lymphadenectomy in patients with prostate cancer. We examined 32 patients pN1 (7.2%), with preoperatory PSA < 10 ng/ml. Mean age was 66.7, all these patients were clinically T1-2, mean PSA was 6.89 ng/ml and mean Gleason score 6.7 (< or = 7 in 27/32). Frozen sections and orchiectomy were performed in 8 patients who had macroscopic nodal involvement. In 24 patients with microscopic nodal involvement retropubic radical prostatectomy was performed. Pathologic stadiation (TNM 1997) was: 1 pT2a N1, 6 pT2b N1, 2 pT3a N1, 14 pT3b N1 and 1 pT4 N1. Seminal vesicle involvement was found in 14 of patients; in 13 of these positive surgical margins was found. Definitive Gleason score was > or = 7 in 22/24 patients (mean 7.7). Five patients underwent adjuvant radiotherapy, 13 radiotherapy and hormonotherapy and 6 only hormonotherapy. Mean follow up was at 66.6 months, but data are available for only 29/32 patients, with 8 (27.5%) biochemical progressions and 2 deaths (10.3%) for metastatic disease. Our experience indicates that the pelvic lymphadenectomy is very important for correct staging, also when PSA <10 ng/mI, bioptic Gleason score < or = 7 and clinical stage T1-2. In pN1 patients the adjuvant hormonotherapy allows a significant extension of disease free survival. [ABSTRACT FROM AUTHOR]

Laparoscopic radical nephrectomy is a standard procedure performed in many institutes. Major vascular complications, especially vena cava injury, are uncommon but serious. Early recognition and conversion to open procedure may be required. We report a case of vena cava injury during transperitoneal laparoscopic radical nephrectomy managed laparoscopically by a surgeon with an extensive experience with intracorporeal suturing, who operated at our institute as a tutor. Major vascular injuries during Iaparoscopic surgery are rare, with an incidence of 0.05%; they are due to malfunction of the instruments, errors made during dissection, misplacement of stapling devices during ligation and disorientation of the surgical field. In literature only two cases of vena cava transection during laparoscopic nepherectomy are reported. The result of these injuries is usually hemorrhage; traditional therapy is emergency laparotomy, consultation with a vascular surgeon and open repair, especially during retroperitoneal laparoscopy, where the available working space is limited and creates a special challenge for control of vascular accidents and performance of laparoscopic suturing maneuvers. The occurrence of major vascular accidents during laparoscopy and the rate of open conversion are related to operator. Vena cava injury during laparoscopic radical nephrectomy is a highly unlikely but potentially devastating complication, that in selected circumstances, can be managed laparoscopically only by surgeons with an extensive experience especially in intracorporeal suturing. [ABSTRACT FROM AUTHOR]