Evaluation of complications and biochemical recurrence rates after (super) extended lymph node dissection during radical prostatectomy.
Humans
Male
Prostatectomy
/ methods
Lymph Node Excision
/ methods
Prostatic Neoplasms
/ surgery
Middle Aged
Neoplasm Recurrence, Local
/ epidemiology
Aged
Postoperative Complications
/ epidemiology
Retrospective Studies
Lymphatic Metastasis
Robotic Surgical Procedures
Prostate-Specific Antigen
/ blood
Pelvis
Biochemical recurrence
Complications
Oncological outcomes
Pelvic lymph node dissection (PLND)
Prostate cancer
Prostatectomy
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
30 Oct 2024
30 Oct 2024
Historique:
received:
07
05
2024
accepted:
11
10
2024
medline:
31
10
2024
pubmed:
30
10
2024
entrez:
30
10
2024
Statut:
epublish
Résumé
To evaluate the effectiveness of extended (e-PLND) and super-extended pelvic lymph node dissection (se-PLND) during robot-assisted radical prostatectomy (RARP) by examining lymph node (LN) yield, complications, LN metastasis, and biochemical recurrence (BCR) incidence. Between January 2016 and January 2020, 354 consecutive patients with > 5% risk of lymph node involvement (LNI), as predicted by the Memorial Sloan Kettering Cancer Center nomogram, underwent RARP with (s)e-PLND at a high-volume center. The e-PLND involved removing fibrofatty lymphatic tissue around the obturator fossa, internal iliac region, and external iliac vessels. The se-PLND, performed at the discretion of the surgeons, also included lymph nodes from the pre-sacral and common iliac regions. Outcomes included histopathological findings by anatomical region; complications; and BCR incidence during follow-up. The median LNI risk was 18% (IQR 9-31%). A median of 22 LN (IQR 16-28) were removed, with se-PLND yielding a higher number: 25 (IQR 20-32) compared to e-PLND: 17 (IQR 13-24) (p < 0.001). pN1 disease was detected in 22% of patients overall, higher in se-PLND (29%) than e-PLND (14%) (p < 0.001). Of metastatic LNs, 14% were situated outside the e-PLND template. Operation time was longer for se-PLND, but perioperative complications were similar between both groups. After a median follow-up of 24 months (IQR 7-33), BCR incidence was comparable between the two groups. Compared to standard extended pelvic lymph node dissection (PLND), super extended PLND increases lymph node yield and removal of metastatic deposits but does not contribute to progression free survival at mid-term.
Identifiants
pubmed: 39476127
doi: 10.1007/s00345-024-05321-6
pii: 10.1007/s00345-024-05321-6
doi:
Substances chimiques
Prostate-Specific Antigen
EC 3.4.21.77
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
605Informations de copyright
© 2024. The Author(s).
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