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Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial

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Abstract

Purpose

To demonstrate the benefits of fluorescence-supported extended pelvic lymph node dissection (ePLND) compared to regular ePLND in robot-assisted radical prostatectomy.

Methods

120 patients with intermediate- or high-risk prostate cancer were prospectively randomized (1:1): in the intervention group, indocyanine green (ICG) was injected transrectally into the prostate before docking of the robot. In both groups, ePLND was performed including additional dissection of fluorescent lymph nodes (LN) in the ICG group.

Results

After drop-out of two patients, 59 patients were allocated to the control (A) and intervention group (B) with a median PSA of 8,6 ng/ml. Median console time was 159 (A) vs. 168 (B) min (p = 0.20) with a longer time for ICG-ePLND: 43 (A) vs. 55 min (B) (p = 0.001). 2609 LN were found with significantly more LN after ICG-supported ePLND with a median of 25 vs. 17 LN in A (p < 0.001). Nodal metastases were detected in 6 patients in A (25 cancerous LN) vs. 9 patients in B (62 positive LN) (p = 0.40). In seven of nine patients, ICG-ePLND identified at least one cancer-positive LN (sensitivity 78%), 27 of 62 cancerous LN were fluorescent. Symptomatic lymphocele occurred in one patient in a and in three patients in b (p = 0.62). After a median follow-up of 22.9 months, PSA levels were similar.

Conclusions

While ICG-ePLND seems to be beneficial for a better understanding of the lymphatic drainage and a more meticulous diagnostic approach, the sensitivity is not sufficient to recommend stand-alone ICG lymph node dissection.

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Authors and Affiliations

  1. Department of Urology, Urooncology and Pediatric Urology, Essen University Hospital, Hufelandstr. 55, 45147, Essen, Germany

    Nina Natascha Harke & Boris Hadaschik

  2. Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany

    Michael Godes, Christian Wagner, Mustapha Addali, Bernhard Fangmeyer, Katarina Urbanova & Jorn H. Witt

Authors
  1. Nina Natascha Harke
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  2. Michael Godes
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  3. Christian Wagner
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  4. Mustapha Addali
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  6. Katarina Urbanova
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  7. Boris Hadaschik
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Contributions

NH Protocol/project development, data collection and management, data analysis, manuscript writing; MG Protocol/project development, data collection and management; CW Data collection and management, manuscript editing; MA Data collection and management; BF Data collection and management; KU Data collection and management, manuscript editing; BH Manuscript editing; JHW Protocol/project development, data collection and management, manuscript editing

Corresponding author

Correspondence to Nina Natascha Harke.

Ethics declarations

Compliance with ethical standards

All procedures in this study involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Informed consent was obtained from all individual participants included in the study.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Harke, N.N., Godes, M., Wagner, C. et al. Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial. World J Urol 36, 1817–1823 (2018). https://doi.org/10.1007/s00345-018-2330-7

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  • DOI: https://doi.org/10.1007/s00345-018-2330-7

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