560: Perioperative Complications of Pelvic Lymphadenectomy in 1380 Patients Undergoing Radical Retropubic Prostatectomy Between 1993 and 2006

Musch, Michael; Klevecka, Virgilijus; Roggenbuck, Ulla; Kroepfl, Darko

doi:10.1016/s0022-5347(18)30800-0

Cited by 11 publications

(37 citation statements)

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“…This information comes with the cost of a longer surgery and an increased likelihood of complications. 24 The reduction in rates of lymph node positivity during PLND as a result of PSA screening that induced stage migration has led to a change in practice patterns, with fewer surgeons performing LND at the time of prostatectomy and fewer nodes obtained when PLND is performed. 25,26 Performance of PLND carries a low risk of direct complication but may also be associated with a low-benefit yield.…”

Section: Patient Selectionmentioning

confidence: 99%

“…18 Larger templates have the advantage of including more of the potential landing sites for the metastatic disease at the cost of additional time to perform the procedure and increased morbidity. 24 Heidenreich et al performed an extended template PLND (ePLND) on 103 consecutive patients and compared this with 100 patients who underwent standard PLND. In the ePLND group, nine lymph node packets were removed in each patient, including bilateral external iliac, internal iliac, obturator, common iliac, and presacral nodes, whereas in the standard PLND group the template was limited to the external and obturator LN packets bilaterally.…”

Section: Anatomic Extent Of Lymph Node Dissectionmentioning

confidence: 99%

“…Vascular injury, hemorrhage, neural or ureteral injury may occur very rarely during PLND. 24 Venous thrombotic events such as deep venous thromboses and pulmonary emboli are theoretical risks associated with PLND; however, some authors have found equal rates of these events in patients who undergo prostatectomy with or without PLND. 40 The rates of all of these complications are generally low in both lPLND and in ePLND (2.6%) but may be as high as 19.8% even in contemporary series.…”

Section: Complications Of Plndmentioning

confidence: 99%

“…33,41 Factors that may influence these rates include anatomic boundaries of PLND, number of nodes removed, operating surgeon, possible lymphatic obstruction with tumor, heparin administration, and transperitoneal or minimally invasive technique. 24,[40][41][42] Musch et al demonstrated a significantly higher rate of complications in patients undergoing ePLND compared with lPLND. In their study of 1380 patients undergoing PLND at the time of radical retropubic prostatectomy, ePLND was associated with a threefold increase in lymphocele formation and was an independent risk factor for reintervention.…”

Section: Complications Of Plndmentioning

confidence: 99%

“…In their study of 1380 patients undergoing PLND at the time of radical retropubic prostatectomy, ePLND was associated with a threefold increase in lymphocele formation and was an independent risk factor for reintervention. 24 Factors that may mitigate the risk of lymphocele, even with ePLND, may include meticulous ligation of the lymphatic drainage as it enters the pelvis, administration of subcutaneous heparin only to the upper extremity, and preserving the fibro-fatty tissue overlying the external iliac artery that contains lymphatics draining the lower extremity. 42,43 PLND and robot-assisted laparoscopicic radical prostatectomy…”

Section: Complications Of Plndmentioning

confidence: 99%

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Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Silberstein

Derweesh

Kane

2009

Prostate Cancer Prostatic Dis

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Since the initial report of robot-assisted laparoscopic prostatectomy (RALP) in 2001, the technique has gained rapid acceptance and utilization. When compared with more traditional forms of surgical intervention, there is still much debate with respect to cost, and impact on potency and continence. Less often is the focus on oncologic outcomes. Pelvic lymph node dissection (PLND) at the time of prostatectomy is an important part of the surgical intervention for prostate cancer and is currently underreported during robotic procedures. Herein, we review the current controversies on the value and extent of PLND and the status of emerging data regarding robot-assisted PLND. IntroductionRadical prostatectomy has undergone an evolution in technique over many decades with older procedures being largely replaced by newer ones due to perceived superiority of oncologic outcomes or diminution of operative morbidity. [1][2][3] In the United States, da Vinci robot-assisted laparoscopic prostatectomy (RALP) has gained rapid popularity because of the facility with which it allows laparoscopic skills to be transferred to even non-laparoscopically trained surgeons. 4 Thus, the benefits of laparoscopy, enhanced optical magnification, decreased blood loss, and minimal incisions can be obtained without prolonged learning curves. Any time a new technique is introduced, it must be compared with current methods to ascertain at least equivalent outcomes, in addition to assessment of benefits, and limitations. To this end, there have been recent publications from the centers of excellence attempting to compare RALP to radical retropubic and pure laparoscopic techniques. 5,6 However, there has been a paucity of literature addressing pelvic lymph node dissection (PLND) at the time of RALP. This is not the case with all urologic robot-assisted procedures; recent literature on robot-assisted radical cystectomy has specifically focused on feasibility and adequacy of robot-assisted PLND. 7 Thus, the lack of literature on robot-assisted PLND at RALP may reflect that PLND at the time of prostatectomy performed through open technique (or otherwise) is a controversial topic. Important questions remain regarding patient selection, potential benefit and anatomic extent of the dissection, nodal yield, and complication rates. We will review these controversies and the state of the literature regarding RALP PLND in this context. Ongoing controversies in PLNDIn the United States, prostate cancer is the most commonly diagnosed noncutaneous cancer and the second-leading cause of cancer death among men. In 2008, 186 320 men were diagnosed with, and 28 660 men died of, prostate cancer in the United States. 8 The advent of prostate-specific antigen (PSA) screening has led to a profound stage migration such that men diagnosed in the PSA era are younger and have lower clinical and pathologic stage and lower mortality rates, and when treated they have improved margin-free status and biochemical progression-free survival and decreased extracapsular extension a...

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Section: Patient Selectionmentioning

confidence: 99%

Section: Anatomic Extent Of Lymph Node Dissectionmentioning

confidence: 99%

Section: Complications Of Plndmentioning

confidence: 99%

Section: Complications Of Plndmentioning

confidence: 99%

Section: Complications Of Plndmentioning

confidence: 99%

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Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Silberstein

Derweesh

Kane

2009

Prostate Cancer Prostatic Dis

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Lymphozele nach radikaler retropubischer Prostatektomie

Anheuser

Treiyer

Stark

et al. 2010

Urologe

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Lymphoceles represent a common complication following pelvic lymphadenectomy and radical retropubic prostatectomy. Relevant articles published in the last 25 years and our own results based on a prospective study were taken as the basis for a treatment algorithm for lymphoceles after radical prostatectomy.The type of intervention depends on the clinical situation of the patient. Symptomatic lymphoceles can be managed initially by percutaneous aspiration with or without instillation of sclerosing agents. However, lymphocele recurrence rates are high. Symptomatic, sterile lymphoceles appear to be ideally suited for drainage by laparoscopic techniques. This method is effective, usually immediately definitive, results in minimal patient morbidity, and allows for a more rapid recovery. Infected lymphoceles require percutaneous or open surgical drainage. Laparoscopic marsupialization of symptomatic lymphoceles after pelvic lymphadenectomy for prostate cancer appears to be safe and effective. Because of the minimal postoperative morbidity, rapid convalescence, and low recurrence rate, laparoscopic lymphadenectomy should be considered as a first-line treatment for symptomatic, uninfected sterile lymphoceles.

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Komplikationen bei radikalen retropubischen Prostatektomien anhand der Martin-Kriterien

Löppenberg

Noldus

Palisaar

2011

Urologe

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Using the Clavien-Dindo classification as a standardized reporting methodology, we observed an acceptable overall complication rate of 28.6%. In the majority (85% of all complications) lower grade complications occurred. In this series older age and a lymphadenectomy were risk factors for high-grade complications (III-V). A patient's age remains an important factor when considering the indication for radical prostatectomy.

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560: Perioperative Complications of Pelvic Lymphadenectomy in 1380 Patients Undergoing Radical Retropubic Prostatectomy Between 1993 and 2006

Cited by 11 publications

References 0 publications

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Lymphozele nach radikaler retropubischer Prostatektomie

Komplikationen bei radikalen retropubischen Prostatektomien anhand der Martin-Kriterien

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