Complications and Other Surgical Outcomes Associated with Extended Pelvic Lymphadenectomy in Men with Localized Prostate Cancer

Briganti, Alberto; Chun, Felix K.-H.; Salonia, Andrea; Suardi, Nazareno; Gallina, Andrea; Pozzo, L. Da; Roscigno, Marco; Zanni, Giuseppe; Valiquette, Luc; Rigatti, Patrìzio; Montorsi, Francesco; Karakiewicz, Pierre I.

doi:10.1016/j.eururo.2006.08.015

Cited by 356 publications

(267 citation statements)

References 23 publications

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“…It is recommended that for each region the nodes should be sent separately for pathologic analysis. With this template, 75% of all anatomical landing sites are cleared, resulting in a better staging accuracy as compared to a limited pelvic lymph node dissection (lPLND), but at the cost of higher complication rates (19.8% vs. 8.2%), mainly related to significant lymphoceles [50].…”

Section: Pelvic Lymph Node Dissectionmentioning

confidence: 99%

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

et al. 2017

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Section: Pelvic Lymph Node Dissectionmentioning

confidence: 99%

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

et al. 2017

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“…4 These complications were similar to the case series of Briganti et al that compared the ePLND with limited PLND during open radical prostatectomy. 64 In that study, the overall complication rate of ePLND was 19.8%. Most prominent complications were lymphocele (10.8%), fever (2.1%), deep venous thrombosis (0.8%) and pelvic hematoma (0.7%).…”

Section: Complicationsmentioning

confidence: 93%

Advances in sentinel node dissection in prostate cancer from a technical perspective

et al. 2015

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Abbreviations & Acronyms ePLND = extended pelvic lymph node dissection FN = false negative ICG = indocyanine green LN = lymph node MRI = magnetic resonance imaging NIR = near-infrared NR = not reported PCa = prostate cancer PET = positron emission tomography PLND = pelvic lymph node dissection SN = sentinel node SPECT-CT = single-photon emission computed tomography combined with computed tomography TRUS = transrectal ultrasound Abstract: The most important feature of sentinel node biopsy for prostate cancer procedure is that staging can be improved. Sentinel nodes might be found outside the extended pelvic lymph node dissection template what renders the sentinel node additive of extended pelvic lymph node dissection. At the same time, staging within the template can be further refined. We reviewed the literature regarding the sentinel node biopsy procedure for prostate cancer. PubMed and Embase were searched for all Englishlanguage publications from January 1999 to September 2014 by using the keywords as "prostate cancer" and "sentinel lymph node" plus "biopsy" "dissection" and/or "procedure." The present review discusses step-by-step sentinel node biopsy for prostate cancer. Topics of discussion are: (i) preoperative sentinel node mapping (tracers and imaging); (ii) intraoperative sentinel node identification (surgical procedure and outcome); and (iii) novelties to improve sentinel node identification (pre-and intraoperative approaches). Conventional sentinel node mapping is carried out after the injection of a 99m Tc-based tracer and subsequent preoperative imaging; for example, lymphoscintigraphy and singlephoton emission computed tomography/computed tomography. This approach allowed the detection of sentinel nodes outside the extended lymph node dissection template in 3.6-36% of men with intermediate-and high-risk prostate cancer. Hereby, an overall false negative rate of sentinel nodes was reported between 0% and 24.4%. To further refine the intraoperative sampling procedure, novel imaging methods such as fluorescence imaging have been introduced. Prospective randomized comparison studies are required to confirm the added benefit of sentinel template directed nodal dissection. A proper and obtainable end-point of such a study could be the number of removed positive nodes for carrying out nodal dissection with or without sentinel template directed dissection. Similarly, the clinical impact of novel imaging technologies requires further investigation.

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“…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. 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.…”

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%

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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Complications and Other Surgical Outcomes Associated with Extended Pelvic Lymphadenectomy in Men with Localized Prostate Cancer

Cited by 356 publications

References 23 publications

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

Advances in sentinel node dissection in prostate cancer from a technical perspective

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

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