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Lymphadenectomy in Prostate Cancer: Technique and Outcomes

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Robotic Urologic Surgery

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Abstract

Despite recent advances in imaging, pelvic lymph node dissection (PLND) remains the gold standard modality for nodal staging in prostate cancer (PCa) patients. There remains significant debate about PLND: the odds of finding positive pelvic lymph nodes are proportional to the extent of the PLND; however, the therapeutic benefits of more extensive PLND remain an area of controversy, besides the increasing number of surgical risks. This chapter will review indications, techniques, and results of extended pelvic lymphadenectomy (ePLND) in the surgical treatment of PCa patients.

Two recent randomized controlled trials comparing extended to limited PLND have not demonstrated differences in early biochemical recurrence.

Limited lymphadenectomy significantly underestimates the actual incidence of lymph node metastasis and should no longer be performed for staging. EPLND is currently the gold standard in lymph node staging. It should be reserved for patients at higher risk of lymph node invasion. The oncological role of ePLND is not defined. It can help patients directly (up to two positive lymph nodes), indirectly (select for adjuvant treatments), or may benefit patients with ISUP Gleason Grade in biopsy 3-5. EPLND is also associated with significantly worse intra- and postoperative non-oncological outcomes, such as bleeding, lymphocele, and increased surgical time. The oncological role of salvage lymphadenectomy also is not clear.

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Authors and Affiliations

  1. Instituto do Cancer do Estado de Sao Paulo – Hospital das Clinicas – Faculdade de Medicina – Universidade de Sao Paulo – ICESP HCFMUSP, São Paulo, Brazil

    Jean Felipe Prodocimo Lestingi

  2. Department of Surgery, Division of Urology, McGill University, Montréal, Canada

    Rafael Sanchez Salas

  3. Department of Urology, Tokyo Medical University, Tokyo, Japan

    Kunihiko Yoshioka

  4. Coordinator of Urology – Instituto do Cancer do Estado de Sao Paulo – Hospital das Clinicas – Faculdade de Medicina – Universidade de Sao Paulo – ICESP HCFMUSP, São Paulo, Brazil

    Rafael Ferreira Coelho

Authors
  1. Jean Felipe Prodocimo Lestingi
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  2. Rafael Sanchez Salas
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  3. Kunihiko Yoshioka
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  4. Rafael Ferreira Coelho
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Editor information

Editors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA

    Peter Wiklund

  2. Department of Urology, ORSI Academy, Aalst, Belgium

    Alexandre Mottrie

  3. Pediatric Urology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA

    Mohan S Gundeti

  4. Urology, Global Robotics Institute, Celebration, FL, USA

    Vipul Patel

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Lestingi, J.F.P., Salas, R.S., Yoshioka, K., Coelho, R.F. (2022). Lymphadenectomy in Prostate Cancer: Technique and Outcomes. In: Wiklund, P., Mottrie, A., Gundeti, M.S., Patel, V. (eds) Robotic Urologic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-00363-9_27

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  • DOI: https://doi.org/10.1007/978-3-031-00363-9_27

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