Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging or increased morbidity?

Touijer, Karim; Fuenzalida, Rodrigo Pinochet; Rabbani, Farhang; Paparel, P.; Nogueira, Lucas; Cronin, Angel M.; Fine, Samson W.; Guillonneau, Bertrand

doi:10.1111/j.1464-410x.2010.09877.x

Cited by 36 publications

(13 citation statements)

References 27 publications

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“…This strategy yields more complications, but is more transparent and objective than an individual surgeon's interpretation of the postoperative period. The low incidence of complications grade 3 or higher in the present series (2%) compares favourably with 4.5% grade 3 complications reported in the only available study reporting complications after transabdominal laparoscopic pelvic extended lymphadenectomy using the Clavien score [8]. 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.…”

Section: Discussionsupporting

confidence: 70%

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

Kjölhede

Sundqvist

2012

Scandinavian Journal of Urology and Nephrology

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Section: Discussionsupporting

confidence: 70%

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

Kjölhede

Sundqvist

2012

Scandinavian Journal of Urology and Nephrology

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“…ePLND has shown a higher detection of nodal metastases (14.3% vs. 4.5%, P =0.004) [12]. Moreover, this dissection also resulted in a statistically significant increase in the median number of nodes resected (13 vs. 9, respectively, P <0.001) [12]. …”

Section: Discussionmentioning

confidence: 99%

Implications of laparoscopic inguinal hernia repair on open, laparoscopic, and robotic radical prostatectomy

Spernat

Sofield

Moon

et al. 2014

Prostate International

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Purpose:There have been anecdotal reports of surgeons having to abandon radical prostatectomy (RP) after laparoscopic inguinal hernia repair (LIHR) due to obliteration of tissue planes by mesh. Nodal dissection may also be compromised. We prospectively collected data from four experienced prostate surgeons from separate institutions. Our objective was to evaluate the success rate of performing open RP (ORP), laparoscopic RP (LRP) and robotic assisted RP (RALRP) and pelvic lymph node dissection (PLND) after LIHR, and the frequency of complications.Methods:A retrospective analysis of prospectively maintained databases of men who underwent RP after LIHR between 2004 and 2010 at four institutions was undertaken. The data recorded included age, preoperative prostate-specific antigen, preoperative Gleason score, and clinical stage. The operative approach, success or failure to perform RP, success or failure to perform PLND, pathological stage, and complications were also recorded.Results:A total of 1,181 men underwent RP between 2004 and 2010. Fifty-seven patients (4.8%) underwent RP after LIHR. An ORP was attempted in 19 patients, LRP in 33, and RALRP in 5. All 57 cases were able to be successfully completed. Ten of the 18 open PLND were able to be completed (55.6%). Four of the 22 laparoscopic LND were able to be completed (18.2%). Robotic LND was possible in 5 of 5 cases (100%). Therefore, it was not possible to complete a LND 56.8% of patients. Complications were limited to ten patients. These complications included one LRP converted to ORP due to failure to progress, and one rectourethral fistula in a salvage procedure post failed high intensity focused ultrasound.Conclusions:LIHR is an increasingly common method of treating inguinal hernias. LIHR is not a contra-indication to RP. However PLND may not be possible in over 50% of patients who have had LIHR. Therefore, these patients may be under-staged and under treated.

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“…In addition, compared to patients omitting PLND, there was a statistically significant increase in postoperative complications (P < 0.001) [12]. The data revealed in Touijer's populaton, if 1,000 patients underwent ePLND compared to no PLND, an additional 140 patients would have nodal metastases detected at the cost of an additional 40 patients experiencing a grade 3 complication [12].…”

Section: Methodsmentioning

confidence: 98%

“…Touijer et al [12] have demonstrated that by including the hypogastric, external iliac and obturator fossa LNs (ePLND) there is a statistically significant increased rate of positive LN detected compared to external iliac node dissection alone. ePLND has shown a higher detection of nodal metastases (14.3% vs. 4.5%, P = 0.004) [12].…”

Section: Methodsmentioning

confidence: 99%

“…The data revealed in Touijer's populaton, if 1,000 patients underwent ePLND compared to no PLND, an additional 140 patients would have nodal metastases detected at the cost of an additional 40 patients experiencing a grade 3 complication [12]. Likewise, for every 10 patients who only underwent an external iliac LN dissection one patient with LN metastases were missed compared with those patients who underwent ePLND [12].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

453 Implications of Laparoscopic Inguinal Hernia Repair on Open, Laparoscopic and Robotic Radical Prostatectomy

Spernat¹,

Woo²,

Sofield³

et al. 2011

European Urology Supplements

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Purpose:There have been anecdotal reports of surgeons having to abandon radical prostatectomy (RP) after laparoscopic inguinal hernia repair (LIHR) due to obliteration of tissue planes by mesh. Nodal dissection may also be compromised. We prospectively collected data from four experienced prostate surgeons from separate institutions. Our objective was to evaluate the success rate of performing open RP (ORP), laparoscopic RP (LRP) and robotic assisted RP (RALRP) and pelvic lymph node dissection (PLND) after LIHR, and the frequency of complications. Methods:A retrospective analysis of prospectively maintained databases of men who underwent RP after LIHR between 2004 and 2010 at four institutions was undertaken. The data recorded included age, preoperative prostate-specific antigen, preoperative Gleason score, and clinical stage. The operative approach, success or failure to perform RP, success or failure to perform PLND, pathological stage, and complications were also recorded.Results: A total of 1,181 men underwent RP between 2004 and 2010. Fifty-seven patients (4.8%) underwent RP after LIHR. An ORP was attempted in 19 patients, LRP in 33, and RALRP in 5. All 57 cases were able to be successfully completed. Ten of the 18 open PLND were able to be completed (55.6%). Four of the 22 laparoscopic LND were able to be completed (18.2%). Robotic LND was possible in 5 of 5 cases (100%). Therefore, it was not possible to complete a LND 56.8% of patients. Complications were limited to ten patients. These complications included one LRP converted to ORP due to failure to progress, and one rectourethral fistula in a salvage procedure post failed high intensity focused ultrasound. Conclusions:LIHR is an increasingly common method of treating inguinal hernias. LIHR is not a contra-indication to RP. However PLND may not be possible in over 50% of patients who have had LIHR. Therefore, these patients may be under-staged and under treated.

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Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging or increased morbidity?

Abstract: • In patients with LNI ≥ 2%, standard PLND detects more nodal metastasis. PLND is associated with higher but non-prohibitive complications rate. • The present study found no evidence that the incidence of complications would be reduced by a limited PLND.

Cited by 36 publications

References 27 publications

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

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

Implications of laparoscopic inguinal hernia repair on open, laparoscopic, and robotic radical prostatectomy

453 Implications of Laparoscopic Inguinal Hernia Repair on Open, Laparoscopic and Robotic Radical Prostatectomy

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