OBJECTIVE: Pelvic lymphadenectomy remains the gold standard for providing a diagnosis of lymph node metastasis (N1) in prostate cancer patients who may be candidates for curatively intended radiotherapy (RT).
The limited lymphadenectomy technique (L-PLND) provides removal of only a minority of lymph nodes within the expected regions of lymph node drainage of the prostate. We describe our extended lymphadenectomy (e-PLND) and the pathological outcome with a modified template as described by Briganti and compare it with L-PLND.
MATERIAL AND METHODS: This was a retrospective study of 44 patients who underwent e-PLND and 36 patients who underwent L-PLND. The lymph node dissection regions were divided into: I the external iliac field, II the obturator field and III the internal iliac field.
RESULTS: The mean age was 70.2 years for e-PLND and 68.9 years for L-PLND. There was no significant difference in preoperative prostate-specific antigen (PSA), Gleason score or clinical stage between the two cohorts of patients. The mean operative time was 95 min. (range 75-140 min.) for e-PLND and 82 min. (range 30-145 min.) for L-PLND (p = 0.03). N1 was found in 18 (41%) and six (17%) in e-PLND versus L-PLND, respectively (p = 0.03). Six of the 44 (13.6%) patients who underwent e-PLND had N1 exclusively outside the region related to the limited dissection technique.
CONCLUSION: e-PLND is safe and can prevent overtreatment of at least 13.6% of the prostate cancer patients who may be candidates for RT. Positive needle-core biopsies have a direct impact on N1.
Written by:
Azawi NH, Stenfeldt K, Christensen T. Are you the author?
Roskilde Hospital, Urologisk Afdeling, Roskilde Sygehus, 4000 Roskilde, Denmark.
Reference: Dan Med J. 2013 Sep;60(9):A4709.
PubMed Abstract
PMID: 24001469
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