Standard versus extended pelvic lymphadenectomy in the patients with clinically localized prostate cancer

Jovo Bogdanović; Vuk Sekulić; Sandra Trivunić-Dajko; Ranko Herin; Senjin Djozić

doi:10.2298/VSP170320076B

Jovo Bogdanović Clinical Center of Vojvodina, Clinic of Urology, Novi Sad, Serbia; University of Novi Sad,Faculty of Medicine, Novi Sad, Serbia
Vuk Sekulić Clinical Center of Vojvodina, *Clinic of Urology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Sandra Trivunić-Dajko Clinical Center of Vojvodina, Center for Pathology and Histology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Ranko Herin Clinical Center of Vojvodina, Clinic of Urology, Novi Sad, Serbia
Senjin Djozić Clinical Center of Vojvodina, Clinic of Urology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP170320076B

Keywords: lymph node excision, pelvis, prostatic neoplasms, prostatectomy, surgical procedures, operative

Abstract

Abstract

Background/Aim. Pelvic lymph node dissection (PLND) is the most accurate staging procedure in the diagnosis of lymph node involvement by prostate cancer. However, the therapeutic value of this procedure is still unclear. The objective of the study was to compare diagnostic and therapeutic values of extended and standard PLND as an adjunct of radical prostatectomy. Methods. The patients who underwent surgical treatment for clinically localized prostate cancer (n = 157) were enrolled in this open nonrandomized prospective study. In the standard PLND (sPLND) group 109 patients were enrolled while the extended PLND (ePLND) group involved 48 patients. Both groups were compared regarding age, prostate-specific antigen (PSA) level, a percentage of positive biopsies, preoperative and postoperative Gleason score, number of retrieved and positive lymph nodes, duration of surgery, blood loss, amount of lymphorrhea and biochemical recurrence-free survival. Results. The average number of retrieved lymph nodes was 17.27 and 24.46 in the sPLND and ePLND group, respectively (p = 0.001). The rate of positive lymph nodes was 9/109 (8.3%) and 8/48 (16.7%) in the sPLND and ePLND groups, respectively. Biochemical recurrence was noted in 38/109 (31.2%) and 7/48 (14.6%) patients in the sPLND and ePLND group, respectively (p = 0.003). Conclusion. Comparison of sPLND to ePLND led to the following conclusions: nodal yield was significantly higher in the ePLND group; the ePLND template was associated with a much higher rate of lymph node metastases; the biochemical recurrence-free survival rate was significantly more favorable in the ePLND group comparing to the sPLND group.

References

REFERENCES

McDowell GC, Johnson JW, Tenney DM, Johnson DE. Pelvic lym-phadenectomy for staging clinically localized prostate cancer. Indications, complications, and results in 217 cases. Urology 1990; 35(6): 476–82.

Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR, et al. Pelvic lymph node dissection in prostate can-cer. Eur Urol 2009; 55(6): 1251‒65.

Briganti A, Chun FK, Salonia A, Gallina A, Zanni G, Scattoni V, et al. Critical assessment of ideal nodal yield at pelvic lym-phadenectomy to accurately diagnose prostate cancer nodal metastasis in patients undergoing radical retropubic prosta-tectomy. Urology 2007; 69(1): 147‒51.

Weingärtner K, Ramaswamy A, Bittinger A, Gerharz EW, Vöge D, Riedmiller H. Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy study and implications for the clinic. J Urol 1996; 156(6): 1969‒71.

Mazzola C, Savage C, Ahallal Y, Reuter VE, Eastham JA, Scardino PT, et al. Nodal counts during pelvic lymph node dissection for prostate cancer: an objective indicator of quality under the influence of very subjective factors. BJU Int 2012; 109(9): 1323‒8.

Silberstein JL, Vickers AJ, Power NE, Parra RO, Coleman JA, Pinochet R, et al. Pelvic lymph node dissection for patients with elevated risk of lymph node invasion during radical prostatectomy: comparison of open, laparoscopic and robot-assisted procedures. J Endourol 2012; 26(6): 748‒53.

Bader P, Burkhard FC, Markwalder R, Studer UE. Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol 2003; 169 (3): 849‒54.

Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL. ISUP Grad-ing Committee. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 2005; 29(9): 1228‒42.

Montironi R, van der Kwast T, Boccon-Gibod L, Bono AV, Boccon-Gibod L. Handling and pathology reporting of radical prosta-tectomy specimens Eur Urol 2003; 44(6): 626‒36.

Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2017; 71(4): 618‒29.

Joniau S, Van den Bergh L, Lerut E, Deroose CM, Haustermans K, Oyen R, et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol 2013; 63(3): 450‒8.

Studer UE, Collette L. Morbidity from pelvic lymphadenecto-my in men undergoing radical prostatectomy. Eur Urol 2006; 50(5): 887‒9.

Capitanio U, Pellucchi F, Gallina A, Briganti A, Suardi N, Salonia A, et al. How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical implications. BJU Int 2011; 107(7): 1095‒101.

Schumacher MC, Burkhard FC, Thalmann GN, Fleischmann A, Studer UE. Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy. Eur Urol 2008; 54(2): 344‒52.

Seiler R, Studer UE, Tschan K, Bader P, Burkhard FC. Removal of limited nodal disease in patients undergoing radical prostatectomy: long-term results confirm a chance for cure. J Urol 2014; 191(5): 1280‒5.

Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU Guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 2011; 59(1): 61‒71.