Extended Pelvic Lymph Node Dissection Including Internal Iliac Packet Should Be Performed During Robot-Assisted Laparoscopic Radical Prostatectomy for High-Risk Prostate Cancer

Abstract

An ePLND that identifies patients with lymph node metastasis including the internal iliac packet during RALP provides an accurate pathologic staging and may have survival benefits in high-risk prostate cancer.

Extended pelvic lymph node dissection at the time of robot-assisted radical prostatectomy: impact of surgical volume on efficacy and complications in a single-surgeon series.

“…Considering that our patients underwent extended PLND, the count of resected nodes may appear low when compared to other series reporting on ePLND. 8,9,14 However, it must be noted that the number and positivity of the dissected lymph nodes depend on the extent of PLND (as well as individual features of the patient and cancer), and these variables can also be influenced by pathological examination due to inter-institutional differences in lymphatic tissue dissection, collection and pathological processing procedures as recently demonstrated by Meijer and colleagues. 15 Several contiguous lymph nodes, for example, may be counted as a single node in some histological institutes and as more than one in others.…”

Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic over-view of the literature

“…Twelve articles made a direct comparison between defined extents of PLND. Of these, seven [7][8][9][10][11][12][13] compared lPLND with no dissection at all and the remaining five [14][15][16][17][18] compared ePLND and lPLND, with one study [18] also including no PLND. In some of the studies, the term standard PLND was used but in these cases the extent matched that of lPLND and so will be referred to as lPLND here.…”

“…Jung et al [14] stated that there was no extra benefit in performing an extended dissection, however, the follow up time used was too short and while a supporting paper by DiMarco et al [20] had an appropriate length of follow up time at 5.8 years and a suitable study size, its use of number of nodes as a surrogate for the extent of PLND and variability in the PLNDs performed by the 5 surgeons make firm conclusions difficult to draw. Its findings are also at odds with the other papers using similar methods.…”

“…When exclusively looking at 200 patients from the high-risk group, Jung et al [14] showed greater rates of diagnosis of lymph node metastasis with ePLND but failed to show improved BCRFS compared to lPLND. The study was limited by the median follow up was just 24 months (interquartile range (IQR): 15-34) and 13 months (IQR: 10-17) respectively.…”

Current technique and results for extended pelvic lymph node dissection during robot-assisted radical prostatectomy

“…The boundaries of the described extended templates are varied, but in general consist of nodes over the hypogastric vessels, the obturator fossa, the external iliac vessels and over the common iliac vessels to the ureteric crossing [7686970] or aortic bifurcation [64] (Supplementary Table 2). The standard or limited template either consisted of the obturator fossa alone [7] or in conjunction with the external iliac nodes [64686970]. The standard PLND (stPLND) yielded between 5–18 nodes, compared to 13–24 in ePLND.…”