„Intermediate-risk-“ und „High-risk-Prostatakarzinompatienten“

Boller, A.; Aksenov, Alexey V.; Naumann, Markus; Jünemann, Klaus-Peter

doi:10.1007/s00120-012-3005-4

Cited by 8 publications

(6 citation statements)

References 17 publications

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“…Thus, during primary RP only 13.3 (3–26) LN were removed on average, only 2.65% of which were positive. These and our previous studies are strong arguments to perform ePLND even during primary RP, especially in intermediate and high-risk patients [12]. These data in conjunction with the BCRF periods show that most patients with LN metastases can live 2 years or more without BCR after salvage surgery of recurrent PCa; in other patients, the PSA progress is at least slowed down.…”

Section: Discussionsupporting

confidence: 62%

“…11 (36.7%) of the primary RP operations in Groups 2 + 3 ( n = 30) were performed at our institution according to the classic technique [10] and were supported by PLND, mostly ePLND [12]. The other 19 (63.3%) patients underwent RP/PLND ex domo; the exact number of removed LNs during primary RP/PLND is mostly unknown, 3 of these did not undergo PLND, and all the others underwent limited PLND.…”

Section: Methodsmentioning

confidence: 99%

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Extended Salvage Pelvic Lymph Node Dissection in Patients with Recurrent Prostate Cancer

Aksenov

Boller

Kalz

et al. 2014

Advances in Urology

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Background. Treatment of patients with a biochemical recurrence (BCR) of prostate cancer (PCa) is generally difficult and without valid treatment options. Since 2004 we have been developing therapeutic possibilities for these patients. Methods. We retrospectively analyzed a cohort of 41 patients with a BCR of PCa and a mean followup of 40.3 ± 20.8 months. Group 1 (n = 10): salvage radical prostatectomy (sRP) with SePLND (salvage extended pelvic lymph nodes dissection) (initial treatment: combined brachytherapy). Group 2 (n = 22): SePLND (initial treatment: radical prostatectomy (RP)). Group 3 (n = 9): SePLND (initial treatment: RP and adjuvant radiation therapy (RT)). We observed PSA, PSA-velocity, localization of LNs and LNs+, BCR-free period, and BR (biochemical response). Results. Group 1: 60% with BCR-freedom (mean 27.2 months). Group 2: 63.6% with BCR-freedom (mean 17.5 months). Group 3: 33.3% with BCR-freedom (mean 17.6 months). In total, BCR-freedom was observed in 23 of 41 patients (56.1%) after salvage surgery. 75.6% of all patients showed a BR. 765 LNs were removed and 14.8% of these were LN+. Conclusions. The BCR-free period and BR are comparable in all three groups. Sensibility to ADT can be reestablished and prolonged as a result of SePLND. Multicenter studies are needed for a reliable output.

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Section: Discussionsupporting

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Extended Salvage Pelvic Lymph Node Dissection in Patients with Recurrent Prostate Cancer

Aksenov

Boller

Kalz

et al. 2014

Advances in Urology

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“…Osmonov et al entfernen in ihrer Studie zur ext. LAE zusätzlich noch die sakralen und die retroiliacalen LK aus dem Marcille'schen Dreieck [9].…”

Section: Introductionunclassified

Zusammenhang zwischen der seitenabhängigen präoperativ bestimmten intraprostatischen Tumorlokalisation mittels Stanzbiopsie und HistoScanning und der Lymphknotenmetastasierung des Prostatakarzinoms

et al. 2020

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Zusammenfassung Einleitung Anhand dieser Studie soll untersucht werden, ob es präoperativ möglich ist, mittels Stanzbiopsie oder HistoScanning, die Lymphknotenmetastasenseite/n des Prostatakarzinoms vorherzusagen bzw. einzugrenzen. Material Die Studie ist retrospektiv angelegt. In die Studie werden 56 Patienten eingeschlossen. Einschlusskriterien sind eine radikale Prostatektomie mit extendierter Lymphadenektomie und ein positiver Lymphknotenstatus. Der Zusammenhang zwischen der präoperativ bestimmten Seit des Tumors innerhalb der Prostata und der Seite der Lymphknotenmetastasen wird analysiert. Methoden Die Datenerhebung erfolgt mittels Microsoft® Office 365 Excel und IBM® SPSS® Statistics Subscription. Zur Testung wird der exakte Fisher-Test angewendet. Als statistisch signifikant werden p-Werte < 0,05 gewertet. Ergebnisse Ein signifikanter Zusammenhang zeigt sich zwischen der mittels Stanzbiopsie bestimmten Seite/n des Tumors innerhalb der Prostata und der Seite/n der Lymphknotenmetastasen. Bei 83 % der Patienten mit einem einseitig festgestellten Stanzbiopsiebefund zeigt sich eine Lymphknotenmetastasierung in eine Körperhälfte, ipsilateral oder kontralateral. Ein Anteil von 75 % dieser Patienten hat ausschließlich Lymphknotenmetastasen auf der ipsilateralen Körperseite aufzuweisen. Bezüglich des HistoScannings zeigt sich kein signifikanter Zusammenhang. In der histologischen Begutachtung nach radikaler Prostatektomie zeigt sich bei 89 % der Patienten ein beidseits positiver Tumorbefall. Schlussfolgerung Sowohl die Stanzbiopsie als auch das HistoScanning scheinen die Tumorausdehnung innerhalb der Prostata zu unterschätzen. Auf Grund dieser Ungenauigkeiten ist trotz zum Teil signifikanter Ergebnisse eine Empfehlung der Beschränkung der Lymphadenektomie auf den seitenanalogen Bereich nicht möglich.

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“…Surgical treatment of both localized and locally advanced prostate cancer with curative intention consists of radical prostatectomy and lymphonodectomy. While the organ-related technical procedures of radical prostatectomy are well defined and standardized, the extent of pelvic lymphonodectomy is still a debated issue [27,28]. Standard lymphonodectomy is limited to the removal of lymph nodes in the obturator fossa and along the external iliac vessels, and has been recommended for locally limited prostate cancer in patients with a low risk profile.…”

Section: Surgerymentioning

confidence: 99%

Embryological Development and Topographic Anatomy of Pelvic Compartments—Surgical Relevance for Pelvic Lymphonodectomy

Bayer

Heinze

Alkatout

et al. 2021

JCM

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Background: The oncological outcome of surgery for the treatment of pelvic malignancies can be improved by performing pelvic lymphonodectomy. However, the extent and regions of lymph node harvest are debated and require profound knowledge of anatomy in order to avoid collateral damage. Methods: The embryological development and topographic anatomy of pelvic compartments in relation to pelvic lymphonodectomy for rectal, uterine, and prostate cancer are reviewed. Based on pre-dissected anatomical specimens, lymph node regions and drainage routes of the posterior and urogenital pelvic compartments are described in both genders. Anatomical landmarks are highlighted to identify structures at risk of injury during pelvic lymphonodectomy. Results: The ontogenesis of urogenital and anorectal compartments and their lymphatic supply are key factors for adequate lymphonodectomy, and have led to compartment-based surgical resection strategies. However, pelvic lymphonodectomy bears the risk of injury to somatic and autonomic nerves, vessels, and organs, depending on the regions and extent of surgery. Conclusion: Embryologically defined, compartment-based resection of pelvic malignancies and their lymphatic drainage routes are based on clearly delineated anatomical landmarks, which permit template-oriented pelvic lymphonodectomy. Comprehensive knowledge of pelvic anatomy, the exchange of surgical concepts between specialties, and minimally invasive techniques will optimize pelvic lymphonodectomy and reduce complications.

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„Intermediate-risk-“ und „High-risk-Prostatakarzinompatienten“

Abstract: At least 15 LNs in the intermediate risk group and at least 18 LNs in high risk group should be removed. The ePLND should include the common iliac artery, the internal iliac artery, Marcille's triangle and sacral regions.

Cited by 8 publications

References 17 publications

Extended Salvage Pelvic Lymph Node Dissection in Patients with Recurrent Prostate Cancer

Extended Salvage Pelvic Lymph Node Dissection in Patients with Recurrent Prostate Cancer

Zusammenhang zwischen der seitenabhängigen präoperativ bestimmten intraprostatischen Tumorlokalisation mittels Stanzbiopsie und HistoScanning und der Lymphknotenmetastasierung des Prostatakarzinoms

Embryological Development and Topographic Anatomy of Pelvic Compartments—Surgical Relevance for Pelvic Lymphonodectomy

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