Complications of Pelvic Lymph Node Dissection for Prostate Cancer

Abstract

Pelvic lymph node dissection (PLND) represents the standard for detection of occult pelvic nodal metastases from prostate cancer, and may be performed separately from or at the time of radical prostatectomy. In addition to its potential for diagnostic staging, a PLND may be therapeutic in some patients. However, considerable debate centers on the appropriate candidates for the procedure, the extent and proper boundaries of dissection, optimal surgical approach, and absolute oncologic benefit. Several series suggest that there likely is limited benefit of PLND in low-risk patients and that PLND can be safely omitted in a high percentage of men undergoing contemporary radical prostatectomy. Furthermore, the value of PLND in patients with intermediate- and high-risk disease must be balanced against the potential morbidity of the procedure. In the setting of this debate, concern over morbidity directly attributable to this procedure is of paramount importance. This review focuses on the complications associated with PLND, including lymphocele, thromboembolic events, ureteral injury, nerve injury, vascular injury, and lymphedema.

Laparoscopic extended pelvic lymphadenectomy for staging can be performed with limited morbidity and short hospital stay in patients with prostate cancer

“…This implies that 65% of patients with advanced prostate cancer can be spared lymphnode radiation [16], and long-term toxicities related to such treatment at the cost of the limited morbidity caused by laparoscopic lymph-node staging, as demonstrated in the present and other modern series [9]. Intensified locoregional treatment in patients with locally advanced prostate cancer is an important field of intensified oncological treatment, as 52% of patients with Gleason score 8 and 64% of patients with Gleason score 9-10 are dead fromtheir disease at 8 years' follow-up when treated with non-curative intent [18].…”

“…Especially favourable in that comparisonis the absence of lymphoceles, deep venous thromboses and pulmonary embolisms in the present series, compared to almost 9% in that study. There are several other series reporting on complications after pelvic lymphadenectomy in prostate cancer patients [9,10] and laparoscopic pelvic lymphadenectomy [3,4,11,12]. It seems that earlier series and open lymphadenectomy have higher complication rates (36%) [3] and rates of lymphoceles (18%) [10] than more recent and laparoscopic series [13,14].…”

Influence of Body Mass Index, Surgical Approach and Lymphadenectomy on the Development of Symptomatic Lymphoceles after Radical Prostatectomy

“…Generally, PLND is well tolerated, regardless of whether it is performed as an isolated laparoscopic staging procedure or simultaneously with open radical retropubic prostatectomy (RRP), conventional laparoscopic prostatectomy or robot-assisted laparoscopic radical prostatectomy (RALP) [1,3]. Overall complication rates vary from 1.2 to 17.7% [1,4].…”

“…Overall complication rates vary from 1.2 to 17.7% [1,4]. The most frequent postoperative complications of PLND are lymphoceles, although not all lymphoceles need further surgical treatment and can be managed conservatively [3,5,6]. The incidence of lymphoceles is reported between 0.6 and 10.3% of the cases [4,7,8].…”

Symptom Frequency, Intensity, and Distress in Patients with Lower Limb Lymphedema

“…16,18 Lower limb lymphedema is also seen in males following prostate surgery. 19 Secondary lower limb lymphedema may also occur due to trauma, 6,20 or following a surgical procedure. 21 Some patient-reported outcome measures have been used to understand the impact of lower limb lymphedema on patients physical and psychosocial functioning.…”