Advertisement

Pelvic Lymphadenectomy for High-Risk Prostate Cancer

  • Chunwoo Lee
  • Dalsan You
Chapter

Abstract

Pelvic lymphadenectomy is considered the most reliable method of diagnosing lymph node metastases and significant adverse prognostic factor in patients with prostate cancer. In the treatment of prostate cancer, however, the clinical benefit of pelvic lymphadenectomy is debatable. In the past, it was common practice not to conduct radical prostatectomy when the lymph node positive results were seen in the frozen section during surgery [1]. Despite the recent efforts to improve clinical outcomes in patients with prostate cancer, pelvic lymphadenectomy remains controversial. Abdollah et al. recently identified that removing more lymph nodes during radical prostatectomy can significantly improve cancer-specific survival in pN1 patients [2]. Therefore, more comprehensive and accurate nodal staging through extended pelvic lymphadenectomy may indirectly [3].

References

  1. 1.
    Gerber GS, Thisted RA, Chodak GW, Schroder FH, Frohmuller HG, Scardino PT, et al. Results of radical prostatectomy in men with locally advanced prostate cancer: multi-institutional pooled analysis. Eur Urol. 1997;32(4):385–90.PubMedPubMedCentralGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    Makarov DV, Trock BJ, Humphreys EB, Mangold LA, Walsh PC, Epstein JI, et al. Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, and biopsy Gleason score (Partin tables) based on cases from 2000 to 2005. Urology. 2007;69(6):1095–101.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Cagiannos I, Karakiewicz P, Eastham JA, Ohori M, Rabbani F, Gerigk C, et al. A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. J Urol. 2003;170(5):1798–803.CrossRefPubMedGoogle Scholar
  5. 5.
    Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol. 2012;61(3):480–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Joslyn SA, Konety BR. Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology. 2006;68(1):121–5.CrossRefPubMedGoogle Scholar
  7. 7.
    von Bodman C, Godoy G, Chade DC, Cronin A, Tafe LJ, Fine SW, et al. Predicting biochemical recurrence-free survival for patients with positive pelvic lymph nodes at radical prostatectomy. J Urol. 2010;184(1):143–8.CrossRefGoogle Scholar
  8. 8.
    Berglund RK, Sadetsky N, DuChane J, Carroll PR, Klein EA. Limited pelvic lymph node dissection at the time of radical prostatectomy does not affect 5-year failure rates for low, intermediate and high risk prostate cancer: results from CaPSURE. J Urol. 2007;177(2):526–9; discussion 9–30.CrossRefPubMedGoogle Scholar
  9. 9.
    Schiavina R, Manferrari F, Garofalo M, Bertaccini A, Vagnoni V, Guidi M, et al. The extent of pelvic lymph node dissection correlates with the biochemical recurrence rate in patients with intermediate- and high-risk prostate cancer. BJU Int. 2011;108(8):1262–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Lestingi JFP, Pontes Jr J, Borges LL, Ravanini J, Guglielmetti GB, Cordeiro MD, et al. Pd43-06 extended vs limited pelvic lymphadenectomy during radical prostatectomy for intermediate- and high-risk prostate cancer: a prospective randomized trial. J Urol. 2015;193(4):e893-e4.CrossRefGoogle Scholar
  11. 11.
    Schwerfeld-Bohr J, Kaemper M, Krege S, Heidenreich A. 270 Prospective randomized multicenter study comparing limited vs extended pelvic lymphadenectomy in intermediate and high risk prostate cancer: comparison of complications (SEAL, AUO AP 55/09). Eur Urol Suppl. 2014;13(1):e270.CrossRefGoogle Scholar
  12. 12.
    Ku JH, Jeong CW, Park YH, Cho MC, Kwak C, Kim HH. Biochemical recurrence after radical prostatectomy with or without pelvic lymphadenectomy in Korean men with high-risk prostate cancer. Jpn J Clin Oncol. 2011;41(5):656–62.CrossRefPubMedGoogle Scholar
  13. 13.
    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(1):63–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71(4):618–29.CrossRefPubMedGoogle Scholar
  15. 15.
    Mohler JL, Antonarakis ES, Armstrong AJ, Bahnson RR, Clark C, D’Amico AV, et al. Prostate cancer, version 2.2017. J Natl Compr Canc Netw. 2017;11:1471–9.CrossRefGoogle Scholar
  16. 16.
    Sanda MG, Chen RC, Crispino T, Freedland S, Greene K, Klotz LH, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol. 2017. pii: S0022-5347(17)78003-2.  https://doi.org/10.1016/j.juro.2017.11.095. [Epub ahead of print].
  17. 17.
    Briganti A, Chun FK, Salonia A, Zanni G, Gallina A, Deho F, et al. A nomogram for staging of exclusive nonobturator lymph node metastases in men with localized prostate cancer. Eur Urol. 2007;51(1):112–9; discussion 9–20.CrossRefPubMedGoogle Scholar
  18. 18.
    Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, et al. Lymph node count threshold for optimal pelvic lymph node staging in prostate cancer. Int J Urol. 2012;19(7):645–51.CrossRefPubMedGoogle Scholar
  19. 19.
    Mattei A, Fuechsel FG, Bhatta Dhar N, Warncke SH, Thalmann GN, Krause T, et al. The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol. 2008;53(1):118–25.CrossRefPubMedGoogle Scholar
  20. 20.
    Inoue S, Shiina H, Arichi N, Mitsui Y, Hiraoka T, Wake K, et al. Identification of lymphatic pathway involved in the spreading of prostate cancer by fluorescence navigation approach with intraoperatively injected indocyanine green. Can Urol Assoc J. 2011;5(4):254–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    Bader P, Burkhard FC, Markwalder R, Studer UE. Is a limited lymph node dissection an adequate staging procedure for prostate cancer? J Urol. 2002;168(2):514–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Burkhard FC, Bader P, Schneider E, Markwalder R, Studer UE. Reliability of preoperative values to determine the need for lymphadenectomy in patients with prostate cancer and meticulous lymph node dissection. Eur Urol. 2002;42(2):84–90; discussion 2.CrossRefPubMedGoogle Scholar
  24. 24.
    Suardi N, Dell'Oglio P, Gallina A, Gandaglia G, Buffi N, Moschini M, et al. Evaluation of positive surgical margins in patients undergoing robot-assisted and open radical prostatectomy according to preoperative risk groups. Urol Oncol. 2016;34(2):57.e1–7.CrossRefGoogle Scholar
  25. 25.
    Abdollah F, Sood A, Sammon JD, Hsu L, Beyer B, Moschini M, et al. Long-term cancer control outcomes in patients with clinically high-risk prostate cancer treated with robot-assisted radical prostatectomy: results from a multi-institutional study of 1100 patients. Eur Urol. 2015;68(3):497–505.CrossRefPubMedGoogle Scholar
  26. 26.
    Yuh B, Artibani W, Heidenreich A, Kimm S, Menon M, Novara G, et al. The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in the management of high-risk prostate cancer: a systematic review. Eur Urol. 2014;65(5):918–27.CrossRefPubMedGoogle Scholar
  27. 27.
    Ham WS, Park SY, Rha KH, Kim WT, Choi YD. Robotic radical prostatectomy for patients with locally advanced prostate cancer is feasible: results of a single-institution study. J Laparoendosc Adv Surg Tech A. 2009;19(3):329–32.CrossRefPubMedGoogle Scholar
  28. 28.
    Sagalovich D, Calaway A, Srivastava A, Sooriakumaran P, Tewari AK. Assessment of required nodal yield in a high risk cohort undergoing extended pelvic lymphadenectomy in robotic-assisted radical prostatectomy and its impact on functional outcomes. BJU Int. 2013;111(1):85–94.CrossRefPubMedGoogle Scholar
  29. 29.
    Yuh BE, Ruel NH, Mejia R, Wilson CM, Wilson TG. Robotic extended pelvic lymphadenectomy for intermediate- and high-risk prostate cancer. Eur Urol. 2012;61(5):1004–10.CrossRefPubMedGoogle Scholar
  30. 30.
    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. Journal of Laparoendosc Adv Surg Tech A. 2012;22(8):785–90.CrossRefGoogle Scholar
  31. 31.
    Jayram G, Decastro GJ, Large MC, Razmaria A, Zagaja GP, Shalhav AL, et al. Robotic radical prostatectomy in patients with high-risk disease: a review of short-term outcomes from a high-volume center. J Endourol. 2011;25(3):455–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Keegan KA, Cookson MS. Complications of pelvic lymph node dissection for prostate cancer. Curr Urol Rep. 2011;12(3):203–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Heidenreich A, Ohlmann CH, Polyakov S. Anatomical Extent of Pelvic Lymphadenectomy in Patients Undergoing Radical Prostatectomy. Eur Urol. 2007;52(1):29–37.CrossRefPubMedGoogle Scholar
  34. 34.
    Lebeis C, Canes D, Sorcini A, Moinzadeh A. Novel technique prevents lymphoceles after transperitoneal robotic-assisted pelvic lymph node dissection: peritoneal flap interposition. Urology. 2015;85(6):1505–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of UrologyGyeongsang National University Changwon Hospital, Gyeongsang National University School of MedicineChangwonSouth Korea
  2. 2.Department of UrologyAsan Medical Center, University of Ulsan College of MedicineSeoulSouth Korea

Personalised recommendations