Laparoscopic Radioisotope-Guided Sentinel Lymph Node Dissection in Staging of Prostate Cancer

Jeschke, Stephan; Beri, Avi; Grüll, Martin; Ziegerhofer, Josef; Prammer, Peter; Leeb, Karl; Sega, Wolfgang; Janetschek, Guenter

doi:10.1016/j.eururo.2007.03.064

Cited by 81 publications

(51 citation statements)

References 20 publications

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“…In 4.1-25% of patients, SN outside the ePLND template were found, whereas 3.5-17% of patients with positive LN had SN metastases outside the ePLND template. 5,7,8,[23][24][25]27,28,31,33,37,[43][44][45]47,[49][50][51][52][53][54] In these studies, the median percentage of positive LN was 20.4% (range 4.7-50) with a FN rate of 1% (range 0-20), respectively.…”

Section: Clinical Implications Of Sn Biopsy For Pcamentioning

confidence: 99%

“…These studies demonstrated that the SN procedure is a reliable tool for staging with high accuracy and minimal complications when comparing the ePLND. 44,46,50,55 Meinhardt et al found that 31% of the patients with local recurrence after radiotherapy had SNs outside of ePLND template, however, metastases in those regions was rare. 37 Vermeeren et al assessed whether the 45 They stated [18F] Fluorocholine PET-CT was not advantageous for detecting occult metastases while the accuracy of laparoscopic SN procedure was comparable with ePLND in these patients.…”

Section: Clinical Implications Of Sn Biopsy For Pcamentioning

confidence: 99%

“…In the literature, the most common complications related to laparoscopic SN procedures reported were lymphocele (0-15%), neuropraxy (0-5%), deep vein thrombosis (0-5%) and mild leg edema (0-5.7%). 46,50,65 The slightly high complication rates of laparoscopic SN procedures than open SN might be associated with the low reporting rate of early series of open SN.…”

Section: Complicationsmentioning

confidence: 99%

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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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Section: Clinical Implications Of Sn Biopsy For Pcamentioning

confidence: 99%

Section: Clinical Implications Of Sn Biopsy For Pcamentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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

et al. 2015

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“…Although magnetic resonance lymphangiography and radioisotope-guided sentinel lymph node detection are less invasive measures that hold promise, the only reliable method for determining lymph node invasion (LNI) is through PLND. 13,14 Staging information obtained through PLND may help to determine the need for additional therapies. Messing et al, 15,16 in a multiinstitutional randomized trial of 98 men with lymph node-positive prostate cancer, demonstrated that patients receiving immediate androgen deprivation therapy (ADT) had significant improved overall survival, prostate-cancer specific survival, and progression-free survival compared with patients who received ADT at the time of symptomatic recurrence or detection of distant metastases.…”

Section: Ongoing Controversies In 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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“…The second is the radioisotope-guided (RI-guided) approach, lymphatic pathway identified by fluorescence navigation which can accurately determine the location of even deep SLNs, but cannot identify minute lymphatic vessels. 5 To identify the SLN in prostate cancer, one must understand the anatomy of the lymphatic network and its flow around the prostate. Normal prostate lymphatics drain into the periprostatic subcapsular network, from which originate three groups of pathways: (1) the ascending principle pathway running along inferior vesical vessels to internal iliac LNs; (2) the second lateral pathway going over bladder to external iliac LNs, forming a perivesical plexus; and (3) the posterior pathway running along the lateral side of the rectum reaching promontorial and lateral sacral LNs.…”

Section: Introductionmentioning

confidence: 99%

Identification of lymphatic pathway involved in the spreading of prostate cancer by fluorescence navigation approach with intraoperatively injected indocyanine green

Inoue

Shiina

Arichi

et al. 2013

CUAJ

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Objective: The objective of this study was to identify lymphatic vessels draining from the prostate by using a fluorescence navigation (FN) system. Methods: Fourteen subjects were candidates for radical retropubic prostatectomy (RRP) and pelvic lymph node dissection (PLND). After an indocyanine green solution was injected into the prostate during RRP, lymphatic vessels draining from the prostate were analyzed using a FN system. After PLND based on lymphatic mapping by the FN system (in vivo probing) was performed in the external iliac, obturator and internal iliac regions; the fluorescence of the removed lymph nodes (LNs) was analyzed on the bench (ex vivo probing). Results: Under in vivo and ex vivo probing, the fluorescence intensity of internal iliac nodes was greater than that of external iliac or obturator nodes. Conclusion:The current study suggests that using a FN system after injecting indocyanine green is a safe and rational approach for detecting the lymphatic channel draining from the prostate. The major lymphatic pathway involved in the spreading of prostate cancer appears to relate to internal iliac LNs, which would mean that the standard PLND covering external iliac and obturator regions would not keep the cancer from spreading. RésuméObjectif : L'objectif de l'étude était de repérer les vaisseaux lymphatiques quittant la prostate à l'aide d'un système d'imagerie par fluorescence (IF). Méthodologie : Quatorze sujets devaient subir une prostatectomie radicale rétropubienne (PRR) et une lymphadénectomie pelvienne. Après injection d'une solution de vert d'indocyanine dans la prostate pendant la PRR, les vaisseaux lymphatiques drainant la prostate ont été analysés par IF. Une lymphadénectomie pelvienne fondée sur la cartographie lymphatique par IF (exploration in vivo) a ensuite été réalisée dans les régions de la fosse iliaque externe, de l'obturateur et de la fosse iliaque interne; la fluorescence des ganglions lymphatiques retirés a été analysée sans délai (exploration ex vivo). Résultats : Lors de l'exploration in vivo et ex vivo, l'intensité de la fluorescence des ganglions iliaques internes était plus forte que celle des ganglions iliaques externes ou des ganglions obturateurs. Conclusion : Cette étude porte à croire que l'IF après injection de vert d'indocyanine est une méthode sûre et rationnelle pour repérer les vaisseaux lymphatiques drainant la prostate. La principale voie lymphatique de propagation du cancer de la prostate semble être reliée aux ganglions lymphatiques iliaques internes, ce qui signifie que la lymphadénectomie pelvienne standard retirant les ganglions iliaques externes et obturateurs n'empêcherait pas le cancer de se propager.

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Laparoscopic Radioisotope-Guided Sentinel Lymph Node Dissection in Staging of Prostate Cancer

Cited by 81 publications

References 20 publications

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

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

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

Identification of lymphatic pathway involved in the spreading of prostate cancer by fluorescence navigation approach with intraoperatively injected indocyanine green

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