The Template of the Primary Lymphatic Landing Sites of the Prostate Should Be Revisited: Results of a Multimodality Mapping Study

Mattei, Agostino; Fuechsel, Frank G.; Dhar, Nivedita; Warncke, Sebastian; Thalmann, George N.; Krause, Thomas; Studer, Urs E.

doi:10.1016/j.eururo.2007.07.035

Cited by 363 publications

(236 citation statements)

References 18 publications

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“…Indeed, the finding that ePLND results in removal of more LN resulting in greater detection of LNI has been confirmed by other European groups. 33,34 Because of the increased penetrance of PSA screening in the United States, American cohorts may be at lower risk of LNI than European cohorts, and these findings may not be applicable. 35 The average PSA of 103 patients who underwent ePLND in Heidenreich's series was 15.9 ng/ml and included patients with PSA values as high as 129 ng/ml, which may be higher than many contemporary American cohorts.…”

Section: Anatomic Extent Of Lymph Node Dissectionmentioning

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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Section: Anatomic Extent Of Lymph Node Dissectionmentioning

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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“…Although SPECT imaging appears to be a reliable imaging technique, it is time-consuming, expensive, and dependent on the skills of the nuclear medicine specialist [12]. In addition, technetium uptake can be compromised in bulky nodal disease, in which over one third of positive nodes remain unidentified [4].…”

Section: Imaging Studiesmentioning

confidence: 99%

“…Because it has been shown that a significant number of nodes are found outside the area explored, for example, along the internal iliac vessels, along the common iliac vessels, and in the presacral and aortic tissue, some positive nodes may have been missed in that study, resulting in incomplete sampling [4,10,11]. Indeed, after applying preoperative fusion imaging of single-photon emission computed tomography (SPECT) and CT scans 1 hour after intraprostatic injection of technetium-99m-nanocolloid, a median of 10 (range, 3-19) primary landing sites was detected and 30%-40% of these sites were found outside the common area of PLND [4]. Although SPECT imaging appears to be a reliable imaging technique, it is time-consuming, expensive, and dependent on the skills of the nuclear medicine specialist [12].…”

Section: Imaging Studiesmentioning

confidence: 99%

“…Recent data using intraprostatic technetium injections and fused SPECT combined with either CT or MRI to map lymphatic drainage from the prostate have also shown that the prostate has multiple landing sites and that if PLND is limited to the iliac vessels distal to the bifurcation of the common iliac artery, 30%-40% of the lymphatic landing sites are potentially missed (Fig. 3) [4,12]. By including tissue along the common iliac vessels at least up to the ureteric crossing, approximately 75% of all nodes potentially harboring metastases can be removed.…”

Section: Extent Of Plndmentioning

confidence: 99%

“…In addition, an extended PLND was performed in only 23% of the patients. Indeed, the knowledge that primary lymphatic drainage sites of the prostate can go up to the inferior mesenteric artery, which is generally not included in an extended PLND, may again limit the reliability of this and other nomograms [4].…”

Section: Preoperative Assessment Of Pelvic Lymph Nodes Nomogramsmentioning

confidence: 99%

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

2009

Self Cite

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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.

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Prostate Neoplasm

et al. 2019

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The Template of the Primary Lymphatic Landing Sites of the Prostate Should Be Revisited: Results of a Multimodality Mapping Study

Cited by 363 publications

References 18 publications

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

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

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

Prostate Neoplasm

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