Anatomical Extent of Pelvic Lymphadenectomy in Patients Undergoing Radical Prostatectomy

Heidenreich, Axel; Ohlmann, Carsten; Polyakov, Sergej

doi:10.1016/j.eururo.2007.04.020

Cited by 289 publications

(225 citation statements)

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“…Third , because we have never experienced conventional retrograde radical prostatectomy without wide resection (rRP), we couldn't compare the difference between aRP and rRP for intraoperative and postoperative complications in the same institution. Last, although there has been a recent tendency to carry out extended lymphadenectomy for patients with cLAD, 18 a limited number of lymphadenectomies were carried out for the patients in the current study.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of antegrade radical prostatectomy for clinically locally advanced prostate cancer: a comparative study with clinically localized disease

Yamamoto¹,

Kawakami²,

Yonese³

et al. 2010

Int J of Urology

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Objectives:To investigate intraoperative and early postoperative complications of antegrade radical prostatectomy with intended wide resection (aRP) for clinically locally advanced prostate cancer (cLAD) and to compare with those of aRP for clinically localized prostate cancer (cLD). Methods: Between March 1994 and June 2007, 800 consecutive Japanese patients including 625 with cLD and 175 with cLAD underwent aRP and bilateral limited lymphadenectomy. Clinicopathological data including intraoperative and early postoperative complications (within 30 days after operation) were compared between cLD and cLAD groups. Results: No deaths occurred. Operative time and blood loss did not differ significantly between the groups. Intraoperative and early postoperative complications were observed in 11 (1.4%) and 123 (15.4%) of the entire cohort, respectively. Prevalent early postoperative complications were pelvic hematoma, wound infection, urinary retention and lymphocele or prolonged lymph drainage. There were no significant differences in the entire intraoperative and early postoperative complications between the groups. The majority of the early postoperative complications were minor. Conclusions: aRP for cLAD is technically feasible and a safe surgical procedure. If radical prostatectomy could be established as a standard treatment for cLAD in the future, aRP might be valuable as the first step of multimodal treatments.

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Section: Discussionmentioning

confidence: 99%

Feasibility of antegrade radical prostatectomy for clinically locally advanced prostate cancer: a comparative study with clinically localized disease

Yamamoto¹,

Kawakami²,

Yonese³

et al. 2010

Int J of Urology

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“…45 Some support a more limited PLND because they believe that there is less morbidity and lower costs. 18,46 In contrast, Heidenreich et al 10,11 demonstrated that the overall incidence of intraoperative and perioperative complications were similar for limited and extended PLND. Blood loss (650 vs 590 cc), rectal injury (1.1 vs 1%) and obturator injury (2.2 vs 1%) were not significantly different for extended vs limited PLND, respectively.…”

Section: What Are the Complications Of Plnd?mentioning

confidence: 97%

“…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%

“…[33][34][35][36] Some argue that the above studies underestimate metastatic LN risk for a given PSA and Gleason grade because they are based on PLND that did not include the internal iliac fossa. 11 These groups's PLND typically yielded 6-9 LNs and therefore may have understaged the patients for a given PSA and Gleason score. Schumacher and colleagues 37 analyzed patients with a PSA less than 10 ng/ml who underwent RRP and PLND, and found positive lymph nodes in 11% of the men.…”

Section: Who Should Undergo Plnd?mentioning

confidence: 99%

“…Similarly, perioperative complications such as deep vein thrombosis (4.7 vs 6%), emboli (1.2 vs 2%), and lymphoceles (10.6 vs 9%) were not significantly different for extended vs limited PLND, respectively. The following practice recommendations to limit morbidity associated with PLND 11,47 have been made: lymphatics lateral to the external iliac artery should be preserved, lymphatics should be carefully dissected and individually clipped, a postoperative drain should be placed and left until the output is less than 50 cc per 24 h, and lowmolecular-weight heparin should be administered subcutaneously at the time of surgery. It does not appear that PLND affects erectile function after RRP, although most groups do not report potency data.…”

Section: What Are the Complications Of Plnd?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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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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Pelvic Lymphadenectomy

Manganiello

Wagner

2018

Smith's Textbook of Endourology

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Anatomical Extent of Pelvic Lymphadenectomy in Patients Undergoing Radical Prostatectomy

Cited by 289 publications

References 50 publications

Feasibility of antegrade radical prostatectomy for clinically locally advanced prostate cancer: a comparative study with clinically localized disease

Feasibility of antegrade radical prostatectomy for clinically locally advanced prostate cancer: a comparative study with clinically localized disease

Pelvic lymphadenectomy in prostate cancer

Pelvic Lymphadenectomy

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