Extended vs standard pelvic lymphadenectomy during laparoscopic radical prostatectomy for intermediate‐ and high‐risk prostate cancer

Abstract

patients having sPLND and a transperitoneal approach in patients having ePLND. RESULTSPatient age, body mass index, gland weight, prostate-specific antigen level and Gleason grade were similar in the two groups. The ePLND group had a greater proportion of patients with cT3 disease (9.9% vs 4.2%, P = 0.046) and was associated with a longer operating time of 206.5 vs 180.0 min ( P < 0.001) and a higher node count of 17.5 vs 6.1 ( P = 0.002). Blood loss, hospital stay, transfusion and complication rates were similar in the two groups. Lymph node positivity was significantly greater ( P = 0.018) in patients with pathological Gleason grade 7 tumours who had ePLND (9.6% vs 1.0%) but was similar for other grades of tumour. CONCLUSIONBased on these findings, and the results of other studies which show a reduction of prostate cancer-specific mortality of 23% if lymph nodes are positive and 15% if they are negative after ePLND, and the correlation between surgical experience, lymph node yield and positivity, we recommend that all patients undergo ePLND if they are being treated with curative intent for intermediate-and high-risk prostate cancer; ePLND should replace sPLND and surgeons performing < 35 cases of RP a year should stop performing RP.

Does Pelvic Lymph Node Dissection Improve the Biochemical Relapse-Free Survival in Low-Risk Prostate Cancer Patients Treated by Laparoscopic Radical Prostatectomy?

“…13 Heidenreich and coworkers 14 estimated a 20% to 25% probability of detecting occult microscopic lymph node metastases in intermediate-risk patients by extended PLND, and a 30% to 40% probability in high-risk patients. On the other hand, in low-risk prostate cancer, only 1% to 3% of the patients with extended PLND in radical prostatectomy had nodal metastasis.…”

Lymph Nodes Invasion of Marcille’s Fossa Associates with High Metastatic Load in Prostate Cancer Patients Undergoing Extended Pelvic Lymph Node Dissection: The Role of “Marcillectomy”

“…Seventy-five per cent of all anatomical landing sites were included in the standard extended PLND [24]. Extending the anatomical template by adding more nodal areas could increase LNs removed [25], the chance to detect LN invasion [26] improved survival in patients pN0 [27] (virtually due to the occult micro-metastases removal).…”

Cancer Control, Continence, and Potency After Laparoscopic Radical Prostatectomy Beyond the Learning and Discovery Curves

“…Extended PLND was performed in high-risk patients until April 2008 and after that in intermediate-and high-risk patients using a transperitoneal technique previously described by the authors. 11 Intrafascial nerve preservation, including preservation of the lateral prostatic fascia (LPF), was used for patients with low-and intermediate-risk disease, and an interfascial technique, incising the LPF just above the neurovascular bundle (NVB), was used in high-risk, previously potent patients in whom potency preservation was a priority.…”