More extended lymph node dissection template at radical prostatectomy detects metastases in the common iliac region and in the fossa of Marcille

Maderthaner, Lydia; Furrer, Marc A.; Studer, Urs E.; Burkhard, Fiona C.; Thalmann, George N.; Nguyen, Daniel P.

doi:10.1111/bju.13993

Cited by 17 publications

(17 citation statements)

References 25 publications

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“…However, there is still no agreement on the lymph nodal fields that should be removed and different ePLND templates have been proposed [7][8][9].…”

Section: Doi: 101159/000500330mentioning

confidence: 99%

“…The Marcille's triangle or fossa is a pelvic anatomical region, which is limited by the fifth lumbar vertebra medially, from the inner edge of the muscle large psoas laterally, from the upper edge of the wing of the sacrum below [11,12]. LNS of this anatomical are related to the prostate lymphatic system [9]. However, the dissection of Marcille's LNs is a subject that has not been investigated in robotic surgery.…”

Section: Doi: 101159/000500330mentioning

confidence: 99%

“…A systematic review of the literature was performed in June 2018 by our group using the Medline, Scopus, and Web of Science databases, searching for the terms "Marcille's fossa" or "Marcille's Triangle" in all fields of the records. The systematic search identified 8 studies: 1 anatomical study on cadavers [11], 4 in PCa [9,[28][29][30], 3 in bladder cancer [31][32][33]. Only one paper takes into account the "Marcillectomy" as an integral part of the ePLND in PCa patients undergoing open radical prostatectomy [9].…”

Section: Doi: 101159/000500330mentioning

confidence: 99%

“…According to these considerations, Maderthaner et al [9] have evaluated the effect of a new extended PLND template including the common iliac vessels and the Marcille's fossa compared to their previous template. In their study, patients with pN+ disease had positive common iliac and Marcille's fossa LNs 17 and 7%, respectively, without significantly increasing the risk of complications.…”

Section: Doi: 101159/000500330mentioning

confidence: 99%

“…Moreover, Marcille's node involvement was associated with metastases in other template location. Although the Authors performed multivariable logistic regression analysis of variables associated with LN metastases, no data were presented in order to evaluate risk factors associated with Marcille's nodal involvement [9].…”

Section: Doi: 101159/000500330mentioning

confidence: 99%

See 4 more Smart Citations

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”

et al. 2019

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Introduction: To assess the incidence of malignancy involvement of lymph nodes (LNs) in Marcille’s fossa in patients undergoing robot assisted radical prostatectomy (RARP) and extended pelvic lymph nodes dissection (ePLND) for prostate cancer (PCa). Design, Setting, and Participants: Between January 2014 and December 2017, details of patients who underwent RARP and ePLND were prospectively analysed. All the nodal packets were dissected separately, grouped into left and right nodes and submitted in separate packages to dedicated pathologist. Results and Limitations: Two hundred and twenty-one patients underwent ePLND and RARP in the study period. In aggregate, Marcille’s LNs involvement was found in 5 (2.3%) of patients, 2 on the left side and 3 on the right side. Per cent of positive cores and Gleason at biopsy are clinical predictors of LNs invasion; moreover, in the surgical specimen, seminal vesicle invasion and high-grade cancer were factors related to loco-regional metastases. Conclusions: Marcille’s nodes involvement is associated to contemporarily multiple LN metastases in other template locations in high-risk PCa patients. The Marcille’s lymphadenectomy would be recommended when planning an ePLND in high-risk PCa.

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“…However, there is still no agreement on the lymph nodal fields that should be removed and different ePLND templates have been proposed [7][8][9].…”

Section: Doi: 101159/000500330mentioning

confidence: 99%

Section: Doi: 101159/000500330mentioning

confidence: 99%

Section: Doi: 101159/000500330mentioning

confidence: 99%

Section: Doi: 101159/000500330mentioning

confidence: 99%

Section: Doi: 101159/000500330mentioning

confidence: 99%

See 3 more Smart Citations

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”

et al. 2019

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The underestimated posterior lymphatic drainage of the prostate: An historical overview and preliminary anatomical study on cadaver

et al. 2019

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BackgroundThe evidence of pelvic lymph node metastases after radical prostatectomy (RP) with pelvic lymph node dissection (PLND) is one of the strongest prognostic factors for poor oncologic outcome. The extent of PLND, although representing a crucial step in RP, is still controversial. Currently, there is a critical drawback in clinical practice due to the lack of congruence between the known lymphatic drainage and cancer dissemination despite defined management by a surgical approach. We hypothesized the existence of alternative pathways for the lymphatic drainage of the prostate currently not considered in clinical daily practice.MethodsWe carried out a literature review of the anatomic description of nodal drainage of prostate reported by online databases (MEDLINE/PubMed, EBSCO, Web of Science, Ovid, and Scopus) and the original texts since the 18th century, with an additional anatomical dissection on a human cadaver to confirm theoretical data.ResultsThe anatomical dissection study converged with the historical anatomical treatises in describing three groups of lymphatics devoted to carrying out prostatic nodal drainage. Apart from the ascending ducts from the cranial gland leading to the external iliac nodes; the lateral ducts leading to the hypogastric nodes; small lymphatic vessels from the posterior surface of the prostate, directed to the pararectal lymphatic plexus, in the direction of the lateral sacral lymph nodes and those at the sacral promontory (ie, pararectal and presacral lymph nodes) were observed.ConclusionsOur preliminary findings demonstrate that lymphatic drainage of the prostate extends beyond standard nodal templates actually considered in surgical daily practice, despite the knowledge reported by historical anatomical treatises. Further anatomical and experimental evidence are needed to investigate anatomical variability in humans, as well as to add more topographical details.

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Diagnostic and therapeutic value of pelvic lymph node dissection in the fossa of Marcille in patients with clinically localized high‐risk prostate cancer: Histopathological and molecular analyses

et al. 2020

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Background: The optimal extent of lymph node dissection in radical prostatectomy has not been determined. Lymph nodes in the fossa of Marcille, which is an important pelvic lymphatic pathway and candidate for additional dissection, have not been evaluated at the molecular level. Here, we assessed by molecular analysis the presence of occult positive lymph nodes in the fossa of Marcille in patients with clinically localized high-risk prostate cancer.Methods: Fifty-two patients with clinically localized high-risk prostate cancer underwent pelvic lymph node dissection accompanied by robot-assisted radical prostatectomy. All nodal packets were dissected separately and grouped into right and left obturator, external and internal iliac regions (including common iliac region to ureter crossing), and fossa of Marcille. All lymph nodes were bisected and evaluated by histopathological or molecular analysis using a quantitative reverse transcription-polymerase chain reaction. The number of positive lymph nodes in the fossa of Marcille and the difference in detection rate were investigated using histopathological and molecular analyses. Perioperative complication rate and predictive factors for biochemical recurrence were evaluated.Results: In the molecular analysis, there were seven positive lymph nodes in the fossa of Marcille in three patients, which were coexistent with positive nodes in other regions. The detection rate of positive lymph nodes was significantly higher using molecular than histopathological analysis (P < .01). Perioperative complication rate within 90 days after the operation was 25.0% and no Clavien-Dindo grade ≥3 complication was confirmed.Detection of metastasis by histopathological and molecular analysis was a significant factor related to biochemical recurrence in the Cox proportional hazards regression model. Conclusions: No case of positive lymph nodes in the fossa of Marcille that had skipped over other regions was confirmed. Additional lymph node dissection of fossa of Marcille did not lead to complete resection of molecularly positive lymph nodes. K E Y W O R D S lymph node dissection, prostatectomy, reverse transcription-polymerase chain reaction

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More extended lymph node dissection template at radical prostatectomy detects metastases in the common iliac region and in the fossa of Marcille

Abstract: A more extended template detects LN metastases in the common iliac region and the fossa of Marcille and is not associated with a higher risk of complications; however, the overall probability of detecting LN metastases was not significantly higher.

Cited by 17 publications

References 25 publications

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”

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”

The underestimated posterior lymphatic drainage of the prostate: An historical overview and preliminary anatomical study on cadaver

Diagnostic and therapeutic value of pelvic lymph node dissection in the fossa of Marcille in patients with clinically localized high‐risk prostate cancer: Histopathological and molecular analyses

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