Therapeutic Value of Standard Versus Extended Pelvic Lymph Node Dissection During Radical Prostatectomy for High-Risk Prostate Cancer
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Extent of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) remains a subject of debate. Here, we review the literature covering the value of extended PLND (ePLND) during RP for high-risk prostate cancer (PCa) over a standard PLND, with a focus on potential therapeutic advantage. PLND may provide valuable prognostic information to high-risk PCa patients, and incorporating the common iliac and presacral nodes to ePLND templates further improves pathologic nodal staging accuracy. Although increased PLND extent is associated with increased lymphocele/lymphedema rates, it is not associated with increased venous thromboembolism rates. The therapeutic role of ePLND remains uncertain. While recent retrospective studies suggest an increased number of nodes removed within the ePLND template are associated with improved survival outcomes, such retrospective studies cannot completely adjust for the Will Rodgers phenomenon or surgeon-specific factors. Thus, the results of randomized trials are eagerly awaited in this arena.
KeywordsProstate cancer Pelvic lymphadenectomy Extended lymphadenectomy Radical prostatectomy
The authors thank Francesca Dallago for drawing the figure depicting anatomical regions of lymph node dissections.
Compliance with Ethical Standards
Conflict of Interest
Michele Colicchia, Vidit Sharma, Firas Abdollah, Alberto Briganti, and R. Jeffrey Karnes each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Mottet N, Bellmunt J, Briers E, Bolla M, Bourke L, Cornford P, et al. EAU ESTRO SIOG Guidelines on Prostate Cancer. Update March. 2017 Available from: https://uroweb.org/wp-content/uploads/09-Prostate-Cancer_2017_web.pdf;
- 4.NCCN Clinical practice guidelines in oncology: prostate cancer. [Internet]. National Comprehensive Cancer Network web site. 2017. Available from: https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf
- 9.Van Den Bergh L, Lerut E, Haustermans K, Deroose CM, Oyen R, Isebaert S, et al. Final analysis of a prospective trial on functional imaging for nodal staging in patients with prostate cancer at high risk for lymph node involvement. Urol Oncol Semin Orig Investig. 2015;33(3):109.e23–31.CrossRefGoogle Scholar
- 10.Budiharto T, Joniau S, Lerut E, Van Den Bergh L, Mottaghy F, Deroose CM, et al. Prospective evaluation of 11C-choline positron emission tomography/computed tomography and diffusion-weighted magnetic resonance imaging for the nodal staging of prostate cancer with a high risk of lymph node metastases. Eur Urol. 2011;60(1):125–30.CrossRefPubMedGoogle Scholar
- 12.Fossati N, Willemse P-PM, van den Bergh RCN, Van den Broeck T, Yuan CY, Briers E, et al. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol. 2017;Google Scholar
- 13.Cunéo B, Marcille M. Topographie des ganglions ilio-pelviens. Bull etMemoires la Soc d’Anthropologie Paris. 1901;3:653–63.Google Scholar
- 15.• Joniau S, Van Den Bergh L, Lerut E, Deroose CM, Haustermans K, Oyen R, et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol. 2013;63(3):450–8. Precise overview of the lymphatic drainage pattern and definition of dissemination patterns of nodal metastasis in a cohort of patients affected by intermediate high-risk PCa CrossRefPubMedGoogle Scholar
- 19.Weingärtner K, Ramaswamy A, Bi ‘itinger A, Gerharz EW, Voge D, Riedmiller H. Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy study and implications for the clinic. J Urol 1999;156(1):1969–1971.Google Scholar
- 23.Hatzichristodoulou G, Wagenpfeil S, Wagenpfeil G, Maurer T, Horn T, Herkommer K, 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. 2016;34:811–20.CrossRefPubMedGoogle Scholar
- 25.• Kim KH, Lim SK, Kim HY, Shin TY, Lee JY, Choi YD, et al. Extended vs standard lymph node dissection in robot-assisted radical prostatectomy for intermediate- or high-risk prostate cancer: a propensity-score-matching analysis. BJU Int. 2013;112(2):216–23. Retrospective comparative study of ePLND versus sPLND depicting oncological (including a propensity-score-matching analysis) and non-oncological outcomes in intermediate and high-risk PCa patients CrossRefPubMedGoogle Scholar
- 26.Jung JH, Seo JW, Lim MS, Lee JW, Chung BH, Hong SJ, et al. Extended pelvic lymph node dissection including internal iliac packet should be performed during robot-assisted laparoscopic radical prostatectomy for high-risk prostate cancer. J Laparoendosc Adv Surg Tech A. 2012;22(8):785–790.Google Scholar
- 32.Yang Y, Luo Y, Hou G-L, Huang Q-X, Pang J, Gao X. Laparoscopic radical prostatectomy plus extended lymph node dissection in combination with immediate androgen deprivation therapy for cases of pT3-4N0-1M0 prostate cancer: a multimodal study of 8 years’ follow-up. Clin Genitourin Cancer. 2016;14(4):e321–7.CrossRefPubMedGoogle Scholar
- 33.Gandaglia G, De Lorenzis E, Novara G, Fossati N, De Groote R, Dovey Z, et al. Robot-assisted radical prostatectomy and extended pelvic lymph node dissection in patients with locally-advanced prostate cancer. Eur Urol. 2016.Google Scholar
- 34.• Abdollah F, Gandaglia G, Suardi N, Capitanio U, Salonia A, Nini A, et al. More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol. 2015;67(2):212–9. Single-center retrospective study on 315 PCa patients with pathological nodal involvement, showing a potential therapeutic effect of a higher number of removed LNs during RP CrossRefPubMedGoogle Scholar
- 35.Moschini M, Fossati N, Abdollah F, Gandaglia G, Cucchiara V, Dell’oglio P, et al. Determinants of long-term survival of patients with locally advanced prostate cancer: the role of extensive pelvic lymph node dissection. Prostate Cancer Prostatic Dis. 2016;19(10):63–7.Google Scholar
- 36.Seiler R, Studer UE, Tschan K, Bader P, Burkhard FC. Removal of limited nodal disease in patients undergoing radical prostatectomy: Long-term results confirm a chance for cure. J Urol. 2014;191(5):1280–5.Google Scholar
- 41.Froehner M, Wirth MP. Re: Firas Abdollah, Giorgio Gandaglia, Nazareno Suardi, et al. More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol 2015;67:212–9: extended lymph node dissection and the will Rogers phenome Eur Urol. 2015;67(6):e112.Google Scholar