Pelvic lymphadenectomy in prostate cancer

Abstract

This review analyzes the anatomy of the prostate gland's lymphatic drainage, the optimal anatomic extend of pelvic lymph node dissection (PLND) and which dissection may be superior, who should undergo a PLND during prostatectomy, and its potential therapeutic benefits and complications. The prostate gland's lymphatic drainage can be variable, but frequently metastatic disease is found in the internal iliac chain. We conclude that the extended PLND yields the most lymph nodes and therefore may be superior. Some have demonstrated an unproven survival benefit after performing an extended PLND, possibly from removal of occult disease or from more accurate staging.Prostate Cancer and Prostatic Diseases (2008) 11, 320-324; doi:10.1038/pcan.2008 published online 20 May 2008 Keywords: pelvic lymph node dissection; lymph nodes; anatomy; radical retropubic prostatectomyThe role of pelvic lymph node dissection (PLND) during radical prostatectomy has generated considerable debate. The central role of a PLND is to determine the locoregional extent of cancer, and to help evaluate the need for adjuvant therapy and the risk of progression and recurrence. Some believe that PLND is therapeutic and promotes a cancer-specific survival benefit. [1][2][3][4] This review aims to critically analyze: (1) the anatomy of the prostate gland's lymphatic drainage, (2) the anatomic boundaries of PLND and which dissection may be superior, (3) who should undergo a PLND during prostatectomy, (4) the potential therapeutic benefits of performing PLND and (5) the complications of PLND. PLND anatomically definedAnatomic studies have been performed to define the periprostatic subcapsular lymphatic network that drains the prostate. 5,6 The network is composed of the ascending, lateral and posterior groups. The ascending ducts drain into the external iliac lymph nodes, the lateral ducts into the hypogastric node chain, and the posterior ducts draining from the caudal prostate to the subaortic lymph nodes of the sacral promontory. 5,6 Weingartner et al. 7 performed extensive PLND on cadavers. A mean lymph node (LN) yield of 20 was found and the authors suggested that this number serve as a guideline for sufficient PLDN. Interestingly, they analyzed prostate cancer patients's LNs and found that they were relatively enlarged, whether they contained cancer or not, compared to non-cancer cadavers.Three approaches to the PLND have been described: limited, standard and extended. 8,9 (Table 1, Figure 1) The exact nomenclature and surgical boundaries of PLND vary between institutions and lack standardization. International consensus on anatomic boundaries and use of descriptive terminology is needed. 9 Standardization would promote uniformity of practice and improve the comparison of future studies on PLND in prostate cancer.What is the optimal anatomic extend of PLND?Considerable debate exists over the appropriate boundaries of PLND during radical retropubic prostatectomy (RRP). Proponents of the extended PLND argue that it significantly increases yield of ...

Optimization via specific fluorescence brightness of a receptor-targeted probe for optical imaging and positron emission tomography of sentinel lymph nodes

“…39 This can be performed with wide-bandwidth cameras and laparoscopic cameras during robotic-assisted surgery. 40 The goal of the approach is to reduce operative time, improve diagnostic accuracy, and decrease morbidity.…”

How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical implications

“…Although controversies exist regarding the use of a routine bilateral PLND, especially in men with low-and intermediate-risk prostate cancer [1,[14][15][16][17][18][19], PLND remains the most accurate staging procedure for LN invasion [1,20]. Moreover, it has been shown that when PLND is indicated and planned at the time of RRP, this should be extended [7,8].…”

Prostate-specific antigen associates with extensive lymph node invasion in high-risk prostate cancer

“…In literature reviews, the incidence of PCA with nodal involvement ranges between 1.1% and 33.3%, and depends on the median number of removed nodes. [2][3][4][5]15,16 However, the rate of multiple lymph node metastases has rarely been reported and ranges between 4% and 17% of cases. 5 A large multicenter retrospective study has shown that, in high-risk selected patients with at least 10 nodes removed (median 15), the rate of LNI was 36.1%, which included 26.4% of cases having 1 to 3 positive nodes and 9.7% of patients with more than 3 positive lymph nodes.…”

“…9 Although predictors of LNI are well-known form the literature, analysis of factors associated with extensive PLNI are missing. [2][3][4][5][6] The aim of this study was to evaluate clinical predictors of multiple LNI (more than 3 positive nodes) in high-risk PCA.…”