Contemporary minimally‐invasive extended pelvic lymph node dissection for prostate cancer before curative radiotherapy: Prospective standardized analysis of complications

Abstract

Abbreviations & AcronymsObjectives: To prospectively assess contemporary complication rates of minimallyinvasive staging pelvic lymph node dissection before curative radiotherapy for prostate cancer using a standardized classification. Methods: A total of 100 prostate cancer patients underwent laparoscopic or robotassisted pelvic lymph node dissection (95% extended). Surgical outcomes were compared with those of 43 patients undergoing open pelvic lymph node dissection (33% extended).Complications were recorded prospectively during hospitalization and follow-up visits, and graded using Clavien-Dindo classification. Lymphocele size was measured on postoperative magnetic resonance imaging or computed tomography. Results: Of the complications recorded, 10% were grade 1, 3% were grade 2 and 6% were grade 3. No grade 4-5 complications occurred. Compared with open pelvic lymph node dissection, minimally-invasive pelvic lymph node dissection was associated with less blood loss (P = 0.001) and shorter hospital stay (median 3 vs 6 days; P < 0.001), but longer operation time (130 vs 98 min; P < 0.001). The complication rate was similar in both groups. For the entire cohort, overall and symptomatic lymphoceles were seen in 91 (64%) and 18 patients (13%), respectively. On multivariate logistic regression, minimally-invasive surgery was the only independent predictor for lymphocele development (odds ratio 3.99; P = 0.015). Conclusions: Minimally-invasive extended pelvic lymph node dissection before curative radiotherapy is associated with low morbidity. Asymptomatic lymphocele development rate is higher compared with open pelvic lymph node dissection.

Evaluating the Impact of Prostate Only Versus Pelvic Radiotherapy for Pathological Node-positive Prostate Cancer: First Results from the Multicenter Phase 3 PROPER Trial

“…We hypothesized that PLND is the best staging tool and could guide the selection of patients who would benefit E U R O P E A N U R O L O G Y F O C U S X X X ( X X X X ) X X X -X X X from WPRT. Patients with an involved LN risk of >15% according to the Roach formula were referred for PLND staging [29]. At the time of designing the trial, the results of the POP-RT trial were unknown and there was much controversy regarding the performance of WPRT in all patients with high-risk PCa.…”

Salvage Pelvic Lymph Node Dissection in Recurrent Prostate Cancer: Surgical and Early Oncological Outcome

“…Notably, complications seem to be more frequent in the salvage setting than in the primary treatment setting. We recently published data on surgical complications of PLND performed by the same surgeons prior to radiotherapy: primary staging PLND had an overall complication rate of 25%, with 11%, 2%, 4%, and 5% grade 1, 2, 3a, and 3b events [ 22 ]. The 2- to 3-fold higher complication rate following SLND might be attributed to previous pelvic treatment (both surgery and/or radiation therapy) causing local fibrosis and blurring surgical landmarks.…”

Editorial Comment to Contemporary minimally‐invasive extended pelvic lymph node dissection for prostate cancer before curative radiotherapy: Prospective standardized analysis of complications

“…suggest the use of PLND either by open (O‐PLND) of minimally‐invasive access (MI‐PLND) as a means of stratifying intermediate‐ and high‐risk PCa patients for prostate‐only or whole pelvis curative radiotherapy (RT). A total of 45 patients (31%) were found to have LNI out of a total of 154 patients that were prospectively included in both arms of the study . Thus, more than two‐thirds of the study population (69%) safely avoided potential overtreatment and the subsequent side‐effects accompanying whole pelvis RT.…”