Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial

Harke, Nina; Godes, Michael; Wagner, Christian von; Addali, M.; Fangmeyer, Bernhard; Urbanová, Katarína; Hadaschik, Boris; Witt, J.H.

doi:10.1007/s00345-018-2330-7

Cited by 39 publications

(21 citation statements)

References 29 publications

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“…Several reasons for the low sensitivity of a simple ICG injection procedure have been considered, such as a heterogeneous study cohort and skip lesions with a higher metastatic burden 23 . In the present study, six out of 15 metastatic cases had a high metastatic burden.…”

Section: Discussionmentioning

confidence: 59%

“…Harke et al . reported improved quality of ePLND with ICG guidance in their randomized trial 23 . ICG guidance can also be helpful in the detection of residual undissected LNs for surgeons or institutions inexperienced in ePLND.…”

Section: Discussionmentioning

confidence: 99%

“…However, the present data do not support ICG FLNs as SLNs, as Harke et al . reported 23 . We could have identified just 15 metastatic LNs based on ICG fluorescence, and would have missed 29 non‐fluorescent metastases (sensitivity 34.1%).…”

Section: Discussionmentioning

confidence: 99%

“…commented that sensitivity was related to the number of LNs removed 20 . In fact, studies with a mean number of ≥20 LNs removed imply limitations of the simple ICG injection procedure as an SLN method, 20,21,23 except in one report 19 . However, reports in which <20 LNs were removed often concluded that the ICG procedure was effective for detecting cancerous LNs 16–18,22 .…”

Section: Discussionmentioning

confidence: 99%

“…However, the radiotracer‐guided method is problematic due to exposure of the patient to radiation and the need for protective measures. Recently, several reports of an ICG fluorescence‐imaging‐guided technique have described the feasibility and safety of SLN detection in PC 16–23 …”

Section: Introductionmentioning

confidence: 99%

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Impact of indocyanine green‐guided extended pelvic lymph node dissection during robot‐assisted radical prostatectomy

et al. 2020

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Objectives: To evaluate the effectiveness of indocyanine green-guided extended pelvic lymph node dissection during robot-assisted radical prostatectomy for intermediate-to high-risk prostate cancer. Materials and methods: After institutional review board approval, between July 2017 and December 2018, we carried out 100 indocyanine green-guided extended pelvic lymph node dissections in patients with localized intermediate-and high-risk prostate cancer, using the Firefly (Novadaq Technologies, Mississauga, ON, Canada) and da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Indocyanine green was injected transrectally using ultrasound sonography before each surgery. Then, lymphatic drainage patterns and pathological findings were recorded. Results: Lymphatic drainage routes were successfully determined in 91 right-sided and 90 left-sided cases. Five main lymphatic pathways and sites were identified: (i) an internal route (57%); (ii) a lateral route (50%); (iii) a presacral route (20%); (iv) a paravesical artery site (20%); and (v) a pre-prostatic site (5%). Lymph node metastasis was positive in 15 patients, with 44 pathologically confirmed metastatic lymph nodes. Metastatic fluorescent lymph nodes were found in 15 out of 44 lymph nodes (34.1%). For sentinel lymph node identification, the 34% sensitivity and 64.8% specificity rates were detected in regard to identification of lymph node metastasis. Conclusions: Lymphatic drainage patterns from the prostate can be identified and classified using indocyanine green-guided extended pelvic lymph node dissections. Although the direct role of fluorescent lymph nodes in sentinel lymph node identification appears to be limited, the identification of lymphatic pathways could contribute to highquality extended pelvic lymph node dissection during robot-assisted radical prostatectomy.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of indocyanine green‐guided extended pelvic lymph node dissection during robot‐assisted radical prostatectomy

et al. 2020

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Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer

et al. 2022

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Objective: To evaluate the relationship between pre-operative PSA value, 68 Ga-prostate-specific-membrane-antigen (PSMA) PET performance and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa).Patients and methods: The study included 164 patients diagnosed with ≤2 pelvic lymph-node recurrence(s) of PCa documented on 68 Ga-PSMA PET scan and treated with pelvic AE retroperitoneal sLND at 11 high-volume centres between 2012 and 2019. Pathologic findings were correlated to PSA values at time of sLND, categorized in early (<0.5 ng/ml), low (0.5-0.99 ng/ml), moderate (1-1.5 ng/ml) and high (>1.5 ng/ml). Clinical recurrence (CR)-free survival after sLND was calculated using multivariable analyses and plotted over pre-operative PSA value.Results: Median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml, and 131 (80%) patients had one positive spot at PET scan. All patients received pelvic sLND, whereas 91 (55%) men received also retroperitoneal dissection. Median (IQR) number of node removed was 15 (6, 28). The rate of positive pathology increased as a function of pre-operative PSA value, with highest rates for patients with preoperative PSA > 1.5 ng/ml (pelvic-only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, PSA ≤ 0.3 ng/ml was detected in 67 (41%) men. On multivariable analyses, pre-operative PSA was associated with PSA response (p < 0.0001). There were 51 CRs after sLND. After adjusting for confounders, we found a significant,

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Fluorescence-Guided Resections: A Binary Approach to Surgery

Schipmann

Stummer

2020

Digital Surgery

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Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial

Abstract: While ICG-ePLND seems to be beneficial for a better understanding of the lymphatic drainage and a more meticulous diagnostic approach, the sensitivity is not sufficient to recommend stand-alone ICG lymph node dissection.

Cited by 39 publications

References 29 publications

Impact of indocyanine green‐guided extended pelvic lymph node dissection during robot‐assisted radical prostatectomy

Impact of indocyanine green‐guided extended pelvic lymph node dissection during robot‐assisted radical prostatectomy

Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer

Fluorescence-Guided Resections: A Binary Approach to Surgery

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