Department of Surgery, Service of Urology Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Study Type - Therapy (case series) Level of Evidence 4.
To assess, in a risk/benefit analysis, the additional risk for complications and benefits of extending the indications and anatomical limits of pelvic lymph node dissection (PLND).
In total, 971 consecutive patients with clinically localized prostate cancer underwent laparoscopic radical prostatectomy from 2003-2007. Before 1 February 2005, patients with a nomogram probability of lymph node invasion (LNI) < 2% did not undergo PLND (No PLND group), whereas those with a LNI ≥2% had a PLND limited to the external iliac nodal group (limited PLND group). After 1 February 2005, all patients underwent a standard PLND including the external iliac, hypogastric and obturator fossa nodal groups (standard PLND group). The risk parameters were PLND-related complications and operating time. Complications were graded using a modified Clavien classification. The benefit was the detection of nodal metastases.
In the subgroup of patients with a LNI ≥2%, standard PLND was a superior operation than the limited PLND in detecting nodal metastases (14.3% vs 4.5%, respectively; P = 0.003). The risk/benefit of standard vs limited PLND would be one additional grade 3 complication per 20 additional patients with nodal metastases. In the subgroup of patients with LNI < 2%, three patients (1.0%) had positive nodes after a standard PLND. The risk/benefit of standard PLND vs no PLND would be one additional grade 3 complication per three or four additional patients with nodal metastasis. The no PLND group was associated with the lowest risk of grade 1, 2 and 3 complications compared to either the limited or standard PLND groups (P < 0.001).
In patients with LNI ≥2%, standard PLND detects more nodal metastasis. PLND is associated with higher but non-prohibitive complications rate. The present study found no evidence that the incidence of complications would be reduced by a limited PLND.
Written by:
Touijer K, Fuenzalida RP, Rabbani F, Paparel P, Nogueira L, Cronin AM, Fine SW, Guillonneau B.
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Reference: BJU Int. 2010 Dec 24. Epub ahead of print.
doi: 10.1111/j.1464-410X.2010.09877.x
PubMed Abstract
PMID: 21199284
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