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Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effect on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis

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Abstract

Purpose

To assess continence and erectile function (EF) recovery of extended pelvic lymph node dissection (ePLND) versus limited PLND (lPLND) after bilateral nerve-sparing radical prostatectomy (BNSRP).

Methods

Consecutive prostate cancer (PCa) patients undergoing BNSRP were stratified according to D’Amico into two groups: low-risk-PCa lPLND (obturator) and intermediate-/high-risk-PCa ePLND (obturator, external iliac artery, internal iliac artery, common iliac artery). Continence (no pad/one safety pad) and EF (IIEF-5 ≥ 17) recovery were assessed. Patients with phosphodiesterase type 5 inhibitors, neoadjuvant/adjuvant therapy, positive lymph nodes or positive surgical margins were excluded.

Results

From January 2007 to May 2012, a total 966 consecutive patients were included. Four hundred and sixty patients met the inclusion/exclusion criteria: 262 patients had ePLND and 198 patients had lPLND. Mean number of lymph nodes was 20.4 (range 10–65) and 4.7 (range 0–10), respectively (p < 0.001). Continence and spontaneous EF recovery after 12 months were 89.7 versus 93.4 % and 40.4 versus 47.5 %, respectively (all p > 0.05). Patient age at surgery (p = 0.001), preoperative EF (p < 0.001) and pathological tumor stage (p = 0.008), but not ePLND (p = 0.561), were independent predictors of EF recovery. No association was detected for continence recovery. Seven-year BCR-free survival for pT2 PCa was 100 and 94.8 % in lPLND and ePLND, respectively (p = 0.011). For pT3 PCa, this was 94.7 and 81.2 %, respectively (p = 0.287). At 2 years, the trifecta of continence, potency and recurrence freedom was achieved in 47.5 and 44.1 % in lPLND and ePLND, respectively (p = 0.451).

Conclusions

ePLND is not associated with increased risk of postoperative incontinence or erectile dysfunction. Only patient age at surgery, preoperative EF and pathological tumor stage represent predictors of EF recovery.

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Authors’ contribution

G. Hatzichristodoulou involved in project development, data collection and management and data analysis and wrote the manuscript. S. Wagenpfeil and G. Wagenpfeil involved in data analysis. T. Maurer, T. Horn, K. Herkommer and M. Hegemann involved in data collection. J. Gschwend and H. Kübler edited the manuscript.

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Authors and Affiliations

  1. Department of Urology, Technical University of Munich, University Hospital Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany

    Georgios Hatzichristodoulou, Tobias Maurer, Thomas Horn, Kathleen Herkommer, Marie Hegemann, Jürgen E. Gschwend & Hubert Kübler

  2. Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital, Homburg/Saar, Germany

    Stefan Wagenpfeil & Gudrun Wagenpfeil

Authors
  1. Georgios Hatzichristodoulou
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  2. Stefan Wagenpfeil
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  6. Kathleen Herkommer
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  8. Jürgen E. Gschwend
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Correspondence to Georgios Hatzichristodoulou.

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The authors declare that they have no conflict of interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Hatzichristodoulou, G., Wagenpfeil, S., Wagenpfeil, G. et al. Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effect on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis. World J Urol 34, 811–820 (2016). https://doi.org/10.1007/s00345-015-1699-9

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  • DOI: https://doi.org/10.1007/s00345-015-1699-9

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