Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

Abstract

Target audience: Physicians who wish to advance their current knowledge of clinical cancer medicine in genitourinary cancer. LEARNING OBJECTIVES1. Evaluate all patients undergoing radical pelvic surgery to determine whether they should have pelvic lymph node dissection.2. Determine to what extent a pelvic lymph node dissection should be performed and analyze the risks involved.3. Based on best practices, assess whether pelvic lymph node dissection is beneficial for staging and prognosis.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe role of pelvic lymph node dissection (PLND) in both bladder and prostate cancer has recently been generating renewed interest. In an attempt to avoid PLND, both nomograms and imaging studies have been evaluated; however, so far they have shown limited success because of inadequate accuracy in staging patients. The three primary objectives of this review are: to define patients in whom PLND should be performed, to define the extent and consequences of the template for PLND, and to identify the staging and prognostic benefits seen with PLND in bladder and prostate cancer. Based on the findings from this review, we conclude that PLND for bladder cancer patients is undoubtedly beneficial, whereas it is less so for prostate cancer patients, in whom a selection strategy should be employed. PLND, in particular with an extended template, seems to provide superior accuracy for postoperative staging than the presently available imaging studies and may be pivotal when considering adjuvant therapies. Furthermore, it has an impact on survival in high-risk patients, and potentially more so in low-risk cancer patients with occult metastases.

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

“…The template of sPLND, as previously described by Walsh, consisted of obturator and external iliac nodal packets. 19 The template of ePLND encompassed additional tissue on the medial and lateral aspect of the internal iliac vessels as well as along common iliac vessels up to the ureteric crossing, as previously described by Thurairaja et al 20 All patients underwent meticulous PLND before dissection of the prostate. 21 The ePLND was initiated by carefully incising peritoneum over the perceived area of the common iliac bifurcation that was guided by the ureters.…”

Radikal Sistektomi Cerrahisinin Kalitesi Nasıl Ölçülebilir?

“…obturator bölgeden biyopsi sonucu negatifse lenf nodu diseksiyonunun daha kraniale ilerletilmesinin gereksiz olduğunu savunmuşlardır (26). Başka bir çalışmada ise frozen incelemeyi yeterli bulmayıp bütün hastalara genişletilmiş PLND yapılması gerektiği önerilmiştir (27). 2004 yılında yayınlanan bir çalışmada 144 RS yapılan hasta incelenmiş, genişletilmiş ve standart PLND karşılaştırılmıştır.…”

Prostatakarzinom: ein Update

“…Selbst die höhere Anzahl entfernter, scheinbar negativer Lymphknoten verbessert die Prognose. Die Indikation zur Lymphadenektomie stellt sich bei PSA≥10 und/oder GleasonScore >7 [6,7].…”