Extended versus limited pelvic lymphadenectomy during radical prostatectomy for intermediate- and high-risk prostate cancer: Early outcomes from a randomized controlled phase III study.

Lestingi, Jean Felipe Prodocimo; Guglielmetti, Giuliano; Pontes, José; Mitre, Anuar Ibrahim; Sarkis, Álvaro S.; Bastos, Diogo Assed; Riechelmann, Rachel; Mattedi, Rômulo Loss; Cordeiro, Maurício; Coelho, Rafael F.; Srougi, Miguel; Nahas, William Carlos

doi:10.1200/jco.2017.35.15_suppl.5018

Cited by 12 publications

(3 citation statements)

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“…To date, randomized data have demonstrated a significant detection benefit for e-PLND/se-PLND over more limited dissections: gross lymph node yield is improved, and detectable lymph node metastases are increased (45)(46)(47). In a contemporary cohort from the randomized, phase III trial by Lestingi et al, (s)e-PLND yielded a median of 17 nodes versus 3 from l-PLND, and detected 6 times more nodal metastases (45). Nevertheless, despite the improved performance on staging and prognostication, no therapeutic benefit was garnered with similar rates of biochemical recurrence and increased complications.…”

Section: Potential Oncologic Benefitsmentioning

confidence: 99%

A narrative review of pelvic lymph node dissection in prostate cancer

Cheung¹,

Fleshner²,

Sengupta³

et al. 2020

Transl Androl Urol

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Pelvic lymph node dissection (PLND) is an important component in the staging and prognostication of prostate cancer. We performed a narrative review to assess the literature surrounding PLND: (I) the current guideline recommendations and contemporary utilization, (II) the calculation of patient-specific risk to perform PLND using available nomograms, (III) to review the extent of dissection, and its associated outcomes and complications. Due to the improved lymph node yield, better staging, and theoretical improvement in the control of micro-metastatic disease, guidelines have supported the use of (extended-) PLND in patients deemed to be at intermediate or high risk of lymph node involvement (often at a threshold of 5% on modern risk nomograms). However, in practice, real-world utilization of PLND varies considerably due to multiple reasons. Conflicting evidence persists with no clear oncological benefit to PLND, and a small, but important, risk of morbidity. Complications are rare, but include lymphoceles; thromboembolic events; and more rarely, obturator nerve, vascular, and ureteric injury. Furthermore, changing disease incidence and stage migration in the context of earlier detection overall have led to a decreased risk of nodal disease. The trade-offs between the benefits, harms, and risk tolerance/threshold must be carefully considered between each patient and their clinician.

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Section: Potential Oncologic Benefitsmentioning

confidence: 99%

A narrative review of pelvic lymph node dissection in prostate cancer

Cheung¹,

Fleshner²,

Sengupta³

et al. 2020

Transl Androl Urol

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“…There was no benefit in biochemical recurrence (BCR), radiotherapy efficacy, androgen-deprivation therapy (ADT) efficacy, bone metastasis or mortality, and e-PLND significantly increased operative time, intraoperative bleeding volume, length of hospital stay and incidence of postoperative complications [29]. We believe that this is a high-level evidence-based medical research study, but we cannot deny the findings of all previous studies.…”

Section: The Relationship Between the Number Of Lymph Nodes Resected mentioning

confidence: 75%

Applied Anatomy of Pelvic Lymph Nodes and Its Clinical Significance for Prostate Cancer:A Single-Center Cadaveric Study

Jia-Jun

Zai-Sheng

Yi-Yi

et al. 2019

Preprint

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Background Pelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP). Not only can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can also improve the prognosis of patients by eradicating micro-metastases. However, reports of the number of pelvic lymph nodes have generally come from incomplete dissection during surgery, there is no anatomic study that assesses the number and variability of lymph nodes. Our objective is to assess the utility of adopting the lymph node count as a metric of surgical quality for the extent of lymph node dissection during RP for prostate cancer by conducting a dissection study of pelvic lymph nodes in adult male cadavers. Methods All 30 adult male cadavers underwent pelvic lymph node dissection (PLND), and the lymph nodes in each of the 9 dissection zones were enumerated and analyzed. Results A total of 1267 lymph nodes were obtained. The number of lymph nodes obtained by local PLND was 4-22 (14.1±4.5), the number obtained by standard PLND was 16-35 (25.9±5.6), the number obtained by extended PLND was 17-44 (30.0±7.0), and the number obtained by super-extended PLDN was 24-60 (42.2±9.7). Conclusions There are substantial inter-individual differences in the number of lymph nodes in the pelvic cavity. These results have demonstrated the rationality and feasibility of adopting lymph node count as a surrogate for evaluating the utility of PLND in radical prostatectomy, but these results need to be further explored.

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“…Overall, the quality of the evidence was low, and the risk of bias high. Three randomised control trials were available, of which one was reported as conference abstracts only [8,9], and only 4 of the remaining studies were performed prospectively. Evidence is very mixed regarding risks and benefits.…”

Section: Risks and Benefitsmentioning

confidence: 99%

Protocol for a Pilot Study of the NODE Trial, a Prospective Multicentre Randomised Trial of Extended Pelvic Lymph Node Dissection for High-Risk Prostate Cancer

McClintock¹,

Khanani²,

DeRosa³

et al. 2021

SIUJ

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Objectives To test the hypothesis that a randomised trial of extended pelvic lymph node dissection (ePLND) can recruit at a rate acceptable for a larger scale trial. To compare the following secondary endpoints between the 2 arms: the rate of protocol violations, the intraoperative and postoperative morbidity of ePLND, and complications, and to evaluate short-term oncological outcomes comparing biochemical recurrence, clinical recurrence, and survival between arms. Patients and Methods A pilot study will be undertaken at Chris O’Brien Lifehouse and Royal Prince Alfred Hospitals for the NODE trial. Twenty patients will be randomised 1:1 to radical prostatectomy with or withoutePLND. Eligible participants will have high-risk prostate cancer and will be scheduled for robotic radical prostatectomy. High-risk disease will be defined as in the 2019 NCCN guidelines (stage ≥ T3a, ISUP Grade Group ≥ 4 or PSA ≥ 20ng/mL). PSMA PET/CT staging not showing any extraprostatic disease will be required. Quality control measures to ensure consistent delivery of high-quality extended lymph node dissections are in place,and surgeons have been selected for their consistent ability to perform such procedures. Results The trial is currently underway. Conclusion On current available evidence, it is unclear if ePLND provides additional benefit over radicalprostatectomy.

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Extended versus limited pelvic lymphadenectomy during radical prostatectomy for intermediate- and high-risk prostate cancer: Early outcomes from a randomized controlled phase III study.

Cited by 12 publications

References 0 publications

A narrative review of pelvic lymph node dissection in prostate cancer

A narrative review of pelvic lymph node dissection in prostate cancer

Applied Anatomy of Pelvic Lymph Nodes and Its Clinical Significance for Prostate Cancer:A Single-Center Cadaveric Study

Protocol for a Pilot Study of the NODE Trial, a Prospective Multicentre Randomised Trial of Extended Pelvic Lymph Node Dissection for High-Risk Prostate Cancer

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