Laparoscopic sentinel lymph node (SLN) versus extensive pelvic dissection for clinically localized prostate carcinoma

Rousseau, Caroline; Rousseau, Thierry; Bridji, B.; Pallardy, Amandine; Lacoste, J; Campion, Loı̈c; Testard, Aude; Aillet, G.; Mouaden, A.; Curtet, C.; Kraeber-Bodéré, Françoise

doi:10.1007/s00259-011-1975-x

Cited by 19 publications

(12 citation statements)

References 36 publications

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“…The sentinel node lymphadenectomy took place at the same time as hyperextensive lymph node dissection for patients chosen for treatment with radical prostatectomy or with external radiotherapy in order to not disregard a possible variable lymphatic drainage according to the findings observed in preliminary series of patients, as reported in previous publications (14,15). The exclusion criteria were previous pelvic surgery, resection of prostate or inguinal hernia, prior hormonal treatment, and history of recent prostatitis.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic Sentinel Lymph Node Versus Hyperextensive Pelvic Dissection for Staging Clinically Localized Prostate Carcinoma: A Prospective Study of 200 Patients

Rousseau

Campion

et al. 2014

J Nucl Med

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Lymph node metastasis is an important prognostic factor in prostate cancer (PC). The aim of this prospective study was to validate, through laparoscopic surgery, the accuracy of the isotopic sentinel lymph node (SLN) technique correlated with hyperextensive pelvic resection (extended pelvic lymphadenectomy dissection) in patients with localized PC, candidates for local curative treatment. Methods: A transrectal ultrasound-guided injection of 99m Tc-sulfur rhenium colloid (0.3 mL/100 MBq) in each prostatic lobe was performed the day before surgery. Detection was performed intraoperatively with a laparoscopic probe, followed by extensive resection. SLN counts were performed in vivo and confirmed ex vivo. Histologic analysis was performed by hematoxylin-phloxine-safran staining, followed by immunohistochemistry if the SLN was free of metastasis. Results: Two hundred three patients with PC at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 96% (195/203). Thirty-five patients had lymph node metastases, 19 only in the SLN. The false-negative rate was 8.5% (3/35). Unilateral surgical SLN detection did not validate bilateral pelvic lymph node status, and extended pelvic lymphadenectomy dissection was necessary on the opposite side of detection to minimize the false-negative rate (2.8% [1/35]). A significant metastatic sentinel invasion in the common iliac region existed (9.3%) but was always associated with other metastatic node areas. The internal iliac region was the primary metastatic site (40.7%). Finally, this series invalidated any justification for a standard or limited dissection, which would have missed 51.9% and 74.1% of lymph node metastases, respectively. Conclusion: The radioisotope SLN identification method up to the common iliac region is successful to identify sentinel nodes during laparoscopic surgery per hemipelvis to be acceptably considered as an isolated procedure and should be validated for intermediate-and high-risk patients.

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Section: Methodsmentioning

confidence: 99%

Laparoscopic Sentinel Lymph Node Versus Hyperextensive Pelvic Dissection for Staging Clinically Localized Prostate Carcinoma: A Prospective Study of 200 Patients

Rousseau

Campion

et al. 2014

J Nucl Med

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“…The detection rate of the SN procedure ranged 76-100%. 5,8,9,12,23,25,29,31,33,36,[43][44][45][46][47][48] A total of 13-75% of the patients showed one or more SN outside the limited PLND template. In addition, SN were detected outside the standard PLND in 51.8-76.9% of the patients with positive LN.…”

Section: Clinical Implications Of Sn Biopsy For Pcamentioning

confidence: 99%

“…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%

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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“…The SN technique with radio-navigated surgery enables detection of the lymph nodes that have the highest probability of containing metastases based on the patient's own pattern of primary lymphatic drainage, potentially improving the accuracy of the lymph node staging for individual patients. The lymphotropic radioactive tracer is usually injected into the prostate several hours before surgery without regard to the location of the cancer (8)(9)(10)(11)(12)(13)(14). An alternative to this technique was suggested in a study of breast cancer patients, in which early visualisation of SNs (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…An alternative to expanding the standard limits of the ePLND when staging prostate cancer is to implement the sentinel node (SN) technique (8)(9)(10)(11)(12)(13)(14). The SN technique with radio-navigated surgery enables detection of the lymph nodes that have the highest probability of containing metastases based on the patient's own pattern of primary lymphatic drainage, potentially improving the accuracy of the lymph node staging for individual patients.…”

Section: Introductionmentioning

confidence: 99%

Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer

Kjölhede

Bratt

Guðjónsson

et al. 2014

Scandinavian Journal of Urology

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Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer.Kjölhede, Henrik; Bratt, Ola; Gudjonsson, Sigurdur; Sundqvist, Pernilla; Liedberg, Fredrik Link to publication Citation for published version (APA): Kjölhede, H., Bratt, O., Gudjonsson, S., Sundqvist, P., & Liedberg, F. (2015). Simplified intraoperative sentinelnode detection performed by the urologist accurately determines lymph-node stage in prostate cancer. Scandinavian Journal of Urology, 49(2), 97-102. DOI: 10.3109/21681805.2014.968867 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal is currently an extended pelvic lymph node dissection (ePLND), which detects the majority, but not all, of regional lymph node metastases. As an alternative to ePLND, sentinel node (SN) dissection with preoperative isotope injection and imaging has been reported. The objective was to determine whether intraoperative SN detection with a simplified protocol can accurately determine lymph node stage in prostate cancer patients. Materials and methods:Patients with biopsy-verified high-risk prostate cancer with tumour stage T2-3 were included in the study. All patients underwent both ePLND and SN detection. 99m Tc-marked nanocolloid was injected peritumourally by the operating urologist after induction of anaesthesia just prior to surgery. SNs were detected both in-vivo and ex-vivo intraoperatively using a gamma probe. SNs and metastases and their locations were recorded. Sensitivity and specificity were calculated.Results: At least one SN was detected in 72 (87%) of the 83 patients. In 13 (18%) of these 72 patients SNs were detected outside the ePLND template. In six of these 13 patients, the SNs from outside the template contained metastases, which proved to be the only metastases in two. For 12 patients the only metastatic deposit found was a micrometastasis (≤ 2 mm) in a SN. In the 72 patients with detectable SNs, pathological analysis of the SNs correctly categorised 71 and ePLND 70 patients. Conclusions:This protocol yielded results comparable to the commonly used technique of SN detection, but with more cases of non-detection.

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Laparoscopic sentinel lymph node (SLN) versus extensive pelvic dissection for clinically localized prostate carcinoma

Abstract: Laparoscopy is suitable for broad identification of SLN metastasis, and targeted resection of these lymph nodes significantly limits the risk of extended surgical resection whilst maintaining the accuracy of the information.

Cited by 19 publications

References 36 publications

Laparoscopic Sentinel Lymph Node Versus Hyperextensive Pelvic Dissection for Staging Clinically Localized Prostate Carcinoma: A Prospective Study of 200 Patients

Laparoscopic Sentinel Lymph Node Versus Hyperextensive Pelvic Dissection for Staging Clinically Localized Prostate Carcinoma: A Prospective Study of 200 Patients

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

Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer

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