Anatomical Basis for Pelvic Lymphadenectomy in Prostate Cancer: Results of an Autopsy Study and Implications for the Clinic

Weingärtner, K.; Ramaswamy, A.; Bittinger, A.; Gerharz, Elmar W.; Voge, D.; Riedmiller, H.

doi:10.1016/s0022-5347(01)65406-5

Cited by 236 publications

(144 citation statements)

References 26 publications

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“…40 Xylene and other clearance techniques have been used by some to increase lymph node retrieval. 41,42 Fat clearance has been shown to increase lymph node harvest in other tumors such as carcinoma of the colon, 43 but the lymph nodes in colonic mesentery are well defined and lack the degree of fat infiltration seen in the pelvic nodes. Wawroschek et al 42 showed that by examining lymph nodes at several levels, combined with the use of immunohistochemistry, the nodepositive rate in low-risk patients increased from 5 to 11%, but that there was a smaller increase, from 34 to 37%, in intermediate-risk patients.…”

Section: Lymph Node Macroscopic Assessmentmentioning

confidence: 99%

“…44 It has also been suggested that lymph nodes in patients with significant prostate cancers often show reactive change, making them easier to identify. 41 Apart from assessment of the number of lymph nodes and their involvement by tumor, a number of studies have examined the characteristics of the deposits and their association with outcome. The diameter of the largest metastasis (Figure 1d) appears to be more predictive of cancer-specific survival than the number of positive nodes alone, [45][46][47] whereas the presence of extranodal extension has been shown not to be predictive on multivariate analysis.…”

Section: Lymph Node Microscopic Assessmentmentioning

confidence: 99%

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International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes

et al. 2011

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The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the infiltration of tumor into the seminal vesicles and regional lymph nodes were coordinated by working group 4. There was a consensus that complete blocking of the seminal vesicles was not necessary, although sampling of the junction of the seminal vesicles and prostate was mandatory. There was consensus that sampling of the vas deferens margins was not obligatory. There was also consensus that muscular wall invasion of the extraprostatic seminal vesicle only should be regarded as seminal vesicle invasion. Categorization into types of seminal vesicle spread was agreed by consensus to be not necessary. For examination of lymph nodes, there was consensus that special techniques such as frozen sectioning were of use only in high-risk cases. There was no consensus on the optimal sampling method for pelvic lymph node dissection specimens, although there was consensus that all lymph nodes should be completely blocked as a minimum. There was also a consensus that a count of the number of lymph nodes harvested should be attempted. In view of recent evidence, there was consensus that the diameter of the largest lymph node metastasis should be measured. These consensus decisions will hopefully clarify the difficult areas of

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Section: Lymph Node Macroscopic Assessmentmentioning

confidence: 99%

Section: Lymph Node Microscopic Assessmentmentioning

confidence: 99%

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes

et al. 2011

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“…Weingartner et al 37 performed anatomic autopsy PLND and determined that although there was great interindividual variability, 20 lymph nodes were needed for a 'sufficient' PLND. Briganti et al examined the results from 858 patients who underwent radical prostatectomy with PLND and utilized receiver operator characteristic curve coordinates to determine the probability of finding LNI based on the number of LN removed and examined.…”

Section: Nodal Yieldmentioning

confidence: 99%

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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“…The ascending ducts drain into the external iliac lymph nodes, the lateral ducts into the hypogastric node chain, and the posterior ducts draining from the caudal prostate to the subaortic lymph nodes of the sacral promontory. 5,6 Weingartner et al 7 performed extensive PLND on cadavers. A mean lymph node (LN) yield of 20 was found and the authors suggested that this number serve as a guideline for sufficient PLDN.…”

Section: Plnd Anatomically Definedmentioning

confidence: 99%

Pelvic lymphadenectomy in prostate cancer

Breyer

Greene

Dall′Era

et al. 2008

Prostate Cancer Prostatic Dis

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This review analyzes the anatomy of the prostate gland's lymphatic drainage, the optimal anatomic extend of pelvic lymph node dissection (PLND) and which dissection may be superior, who should undergo a PLND during prostatectomy, and its potential therapeutic benefits and complications. The prostate gland's lymphatic drainage can be variable, but frequently metastatic disease is found in the internal iliac chain. We conclude that the extended PLND yields the most lymph nodes and therefore may be superior. Some have demonstrated an unproven survival benefit after performing an extended PLND, possibly from removal of occult disease or from more accurate staging.Prostate Cancer and Prostatic Diseases (2008) 11, 320-324; doi:10.1038/pcan.2008 published online 20 May 2008 Keywords: pelvic lymph node dissection; lymph nodes; anatomy; radical retropubic prostatectomyThe role of pelvic lymph node dissection (PLND) during radical prostatectomy has generated considerable debate. The central role of a PLND is to determine the locoregional extent of cancer, and to help evaluate the need for adjuvant therapy and the risk of progression and recurrence. Some believe that PLND is therapeutic and promotes a cancer-specific survival benefit. [1][2][3][4] This review aims to critically analyze: (1) the anatomy of the prostate gland's lymphatic drainage, (2) the anatomic boundaries of PLND and which dissection may be superior, (3) who should undergo a PLND during prostatectomy, (4) the potential therapeutic benefits of performing PLND and (5) the complications of PLND. PLND anatomically definedAnatomic studies have been performed to define the periprostatic subcapsular lymphatic network that drains the prostate. 5,6 The network is composed of the ascending, lateral and posterior groups. The ascending ducts drain into the external iliac lymph nodes, the lateral ducts into the hypogastric node chain, and the posterior ducts draining from the caudal prostate to the subaortic lymph nodes of the sacral promontory. 5,6 Weingartner et al. 7 performed extensive PLND on cadavers. A mean lymph node (LN) yield of 20 was found and the authors suggested that this number serve as a guideline for sufficient PLDN. Interestingly, they analyzed prostate cancer patients's LNs and found that they were relatively enlarged, whether they contained cancer or not, compared to non-cancer cadavers.Three approaches to the PLND have been described: limited, standard and extended. 8,9 (Table 1, Figure 1) The exact nomenclature and surgical boundaries of PLND vary between institutions and lack standardization. International consensus on anatomic boundaries and use of descriptive terminology is needed. 9 Standardization would promote uniformity of practice and improve the comparison of future studies on PLND in prostate cancer.What is the optimal anatomic extend of PLND?Considerable debate exists over the appropriate boundaries of PLND during radical retropubic prostatectomy (RRP). Proponents of the extended PLND argue that it significantly increases yield of ...

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Anatomical Basis for Pelvic Lymphadenectomy in Prostate Cancer: Results of an Autopsy Study and Implications for the Clinic

Cited by 236 publications

References 26 publications

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes

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

Pelvic lymphadenectomy in prostate cancer

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