Anatomical Extent of Lymph Node Dissection: Impact on Men With Clinically Localized Prostate Cancer

Allaf, Mohamad E.; Palapattu, Ganesh S.; Trock, Bruce J.; Carter, H. Ballentine; Walsh, Patrick C.

doi:10.1097/01.ju.0000140912.45821.1d

Cited by 310 publications

(212 citation statements)

References 16 publications

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“…Others have demonstrated a similar significant increase in LNs and metastasis yield after extended PLND compared to standard or limited PLND. 2,12 Bader et al 13 provided further evidence that an extended PLND is needed to provide adequate clinical staging and potential therapeutic benefit. Men with clinically organ-confined prostate cancer underwent RRP and extended PLND, and had their LNs prospectively evaluated for number and location of LN metastases.…”

Section: Plnd Anatomically Definedmentioning

confidence: 99%

“…Others have demonstrated a similar significant increase in LNs and metastasis yield after extended PLND compared to standard or limited PLND. 2,12 Bader et al 13 16,17 The total number of LNs removed during PLND is vital to ensure the accuracy of the staging procedure. As mentioned earlier, in cadaver studies, a mean LN yield of 20 was found to be sufficient.…”

Section: Plnd Anatomically Definedmentioning

confidence: 99%

“…It has been demonstrated that the number of LNs dissected is directly associated with an increased yield of metastatic LNs. 2,[10][11][12] In contrast, some argue that an extended PLND only causes increased morbidity and cost. Clark et al 18 performed a prospective randomized study of 123 patients undergoing RRP with either limited (external iliac and obturator fossa nodes) or extended (common iliac, internal iliac, external iliac, obturator fossa and presacral nodes) PLND.…”

Section: Plnd Anatomically Definedmentioning

confidence: 99%

“…In addition, a therapeutic and cancer-specific survival benefit may occur after PLND. [1][2][3][4] With the rise of the prostate-specific antigen (PSA) era, a downward stage migration resulting from the earlier detection of prostate cancer has led to a decreased incidence of positive LNs. [20][21][22] To determine who should undergo a PLND, the benefits must be weighed against the associated comorbidities and applied to those who are at risk of metastatic disease.…”

Section: Who Should Undergo Plnd?mentioning

confidence: 99%

“…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. …”

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confidence: 99%

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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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Section: Plnd Anatomically Definedmentioning

confidence: 99%

Section: Plnd Anatomically Definedmentioning

confidence: 99%

Section: Plnd Anatomically Definedmentioning

confidence: 99%

Section: Who Should Undergo Plnd?mentioning

confidence: 99%

mentioning

confidence: 99%

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Pelvic lymphadenectomy in prostate cancer

Breyer

Greene

Dall′Era

et al. 2008

Prostate Cancer Prostatic Dis

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Prostate Neoplasm

et al. 2019

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Racial/ethnic differences in receipt of pelvic lymph node dissection among men with localized/regional prostate cancer

Hayn

Orom

Shavers

et al. 2011

Cancer

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Background Black and Hispanic men have a lower prostate cancer (PCa) survival than White men. This racial/ethnic survival gap has been partially explained by differences in tumor characteristics, stage at diagnosis, and disparities in receipt of definitive treatment. Another potential contributing factor is racial/ethnic differences in timely and accurate detection of lymph node metastases. A study was conducted to examine the association between race/ethnicity and receipt of pelvic lymph node dissection (PLND) among men with localized/regional PCa. Method Logistic regression was used to estimate the adjusted odds of receiving a PLND among men diagnosed (2000–2002) with PCa, who received a radical prostatectomy or a PLND without a radical prostatectomy and who were diagnosed in regions covered by the Surveillance, Epidemiology, and End Results database (n = 40,848). Results Blacks were less likely to have received a PLND than Whites (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.84–0.98). Stratifying by PCa grade revealed that Black men with well (OR 0.48, 95% CI 0.27–0.84) and poorly differentiated PCa (OR 0.73, 95% CI 0.60–0.89) were less likely to have received a PLND than their White counterparts, but racial differences were not found among men with moderately differentiated PCa (OR 0.96, 95% CI 0.88–1.05). Conclusion Among men with poorly differentiated prostate cancer, failure to receive a pelvic lymph node dissection has been associated with worse survival. Racial disparities in receipt of pelvic lymph node dissection, especially among men with poorly differentiated prostate cancer, may contribute to racial differences in prostate cancer survival.

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Anatomical Extent of Lymph Node Dissection: Impact on Men With Clinically Localized Prostate Cancer

Cited by 310 publications

References 16 publications

Pelvic lymphadenectomy in prostate cancer

Pelvic lymphadenectomy in prostate cancer

Prostate Neoplasm

Racial/ethnic differences in receipt of pelvic lymph node dissection among men with localized/regional prostate cancer

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