Abstract
Pelvic lymph node dissection (PLND) represents the standard for detection of occult pelvic nodal metastases from prostate cancer, and may be performed separately from or at the time of radical prostatectomy. In addition to its potential for diagnostic staging, a PLND may be therapeutic in some patients. However, considerable debate centers on the appropriate candidates for the procedure, the extent and proper boundaries of dissection, optimal surgical approach, and absolute oncologic benefit. Several series suggest that there likely is limited benefit of PLND in low-risk patients and that PLND can be safely omitted in a high percentage of men undergoing contemporary radical prostatectomy. Furthermore, the value of PLND in patients with intermediate- and high-risk disease must be balanced against the potential morbidity of the procedure. In the setting of this debate, concern over morbidity directly attributable to this procedure is of paramount importance. This review focuses on the complications associated with PLND, including lymphocele, thromboembolic events, ureteral injury, nerve injury, vascular injury, and lymphedema.
Similar content being viewed by others
References
Papers of particular interest, published recently have been hihglighted as: • Of importance
Cheng L, Zincke H, Blute ML, et al. Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer. 2001;91:66–73.
Messing EM, Manola J, Sarosdy M, et al. Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. NEJM. 1999;341:1781–8.
Schumacher MC, Burkhard FC, Thalmann GN, et al. Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy. Eur Urol. 2008;54:344–52.
• Briganti A, Blute ML, Eastham JH, et al. Pelvic lymph node dissection in prostate cancer. Eur Urol. 2009;55:1251–65. This is a comprehensive review of PLND for prostate cancer.
Kawakami J, Meng MV, Sadetsky N, et al. Changing patterns of pelvic lymphadenectomy for prostate cancer: Results from CaPSURE. J Urol. 2006;176:1382–6.
Weight CJ, Reuther AM, Gunn PW, et al. Limited pelvic lymph node dissection does not improve biochemical relapse-free survival at 10 years after radical prostatectomy in patients with low risk prostate cancer. Urology. 2008;71:141–5.
Weckermann D, Goppelt M, Dorn R, et al. Incidence of positive pelvic lymph nodes in patients with prostate cancer, a prostate specific antigen level of < or = 10 ng/ml and biopsy Gleason score of < or = 6, and their influence on PSA progression free survival after radical prostatectomy. BJU Int. 2006;97:1173–8.
Heidenreich A, Ohlmann CH, Polyakov S. Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy. Eur Urol. 2007;52:29–37.
Schumacher MC, Burkhard FC, Thalmann GN, et al. Is pelvic lymph node dissection necessary in patient with a serum PSA <10 ng/ml undergoing radical prostatectomy from prostate cancer? Eur Urol. 2006;50:272–9.
• Mattei A, Fuechsel FG, Dhar NB, et al. The template of the primary lymphatic landing sites of the prostate should be revisited: results of the multi-modality mapping study. Eur Urol. 2008;53:118–25. This is an important analysis demonstrating that a significant proportion of prostatic primary lymphatic landing sites lie outside even an extended node dissection.
Klein EA, Kattan M, Stephenson A, et al. How many lymphadenectomies does it take to cure one patient? Eur Urol. 2008;53:13–5.
Greene KL, Albertsen PC, Babaian RJ, et al. Prostate specific antigen best practice statement: 2009 update. J Urol. 2009;182:2232–41.
Mori N. Clinical and experimental studies on the so-called lymphocyst which develops after radical hysterectomy in cancer of the uterine cervix. J Jpn Obstet Gyencol Soc. 1955;2:178.
Patel A. Complications of lymphadenectomy. In: Taneja SS, Smith RB, Ehrlich RM, editors. Complications of urologic surgery- prevention and management 3 rd Edition. Philadelphia: Saunders; 2001. p. 370–85.
Solberg A, Angelsen A, Bergan U, et al. Frequency of lymphoceles after open and laparoscopic pelvic lymph node dissection in patients with prostate cancer. Scand J Urol Nephrol. 2003;37:218–21.
• Loeb S, Partin AW, Schaeffer EM. Complications of pelvic lymphadenectomy: do the risks outweigh the benefits? Rev Urol. 2010;12:20–4. This is a recent review that addressed complications of pelvic lymphadenectomy for prostate cancer.
Catalona WJ, Kadmon D, Crane D. Effect of mini-dose heparin on lymphocele formation following extraperitoneal pelvic lymphadenectomy. J Urol. 1980;123:890–2.
Basinger GT, Gittes RF. Lymphocyst: ultrasound diagnosis and urologic management. J Urol. 1975;114:740.
Clark T, Parekh DJ, Cookson MJ, et al. Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol. 2003;169:145–7.
Musch M. Klevecka, Roggenbuck U, et al. Complications of pelvic lymphadenectomy in 1380 patients undergoing radical retropubic prostatectomy between 1993 and 2006. J Urol. 2008;179:923–8.
Heidenreich A, Varga Z, Von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol. 2002;167:1681–6.
Briganti A, Chun FK, Salonia A, et al. Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol. 2006;50:1006–13.
Fallick ML, Long JP. Laparoscopic marsupialization of lymphocele after laparoscopic lymph node dissection. J Endourol. 1996;10:533.
Treiyer A, Haben B, Stark E, et al. Uni- vs. Multiloculated pelvic lymphoceles: different treatment of symptomatic pelvic lymphoceles after open radical retropubic prostatectomy. It Braz J Urol. 2009;35:164–70.
Zorn KC, Katz MH, Bernstein A, et al. Pelvic lymphadenectomy during robot assisted radical prostatectomy: Assessing nodal yield, perioperative outcomes, and complications. Urol. 2009;74:296–302.
Nicolaides AN, Breddin HK, Fareed J, et al. Prevention of venous thromboembolism. International consensus statement. J Vasc Biol. 2002;1:133–70.
Forrest JB, Clemens JQ, Finamore P, et al. AUA Best Practice Statement for the prevention of deep vein thrombosis in patients undergoing urologic surgery. J Uro. 2009;181:1170–7.
Lein M, Stibane I, Mansour R, et al. Complications, urinary continence, and oncologic outcome of 1000 laparoscopic transperitoneal radical prostatectomies- Experience at the Charite’ hospital Berlin, campus Mitte. Eur Urol. 2006;50:1278–84.
Ficarra V, Novara F, Artibani W, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009;55:1037–63.
Kavoussi LR, Sosa E, Chandhoke P, et al. Complications of laparoscopic pelvic lymph node dissection. J Urol. 1993;149:322–5.
Stone NN, Stock RG, Unger P. Laparoscopic pelvic lymph node dissection for prostate cancer: comparison of the extended and modified techniques. J Urol. 1997;158:1891–4.
Katz DJ, Yee DS, Guilherme G, et al. Lymph node dissection during robotic-assisted laparoscopic prostatectomy: comparison of lymph node yield and clinical outcomes when including common iliac nodes with standard template dissection. BJU Int. 2010;106:391–6.
Lallas CD, Pe ML, Thumar AB, et al. Comparison of lymph node yield in robot-assisted laparoscopic prostatectomy with that in open radical retropubic prostatectomy. BJU Int 2010; epub
Campbell SC, Klein EA, Levin HS, et al. Open pelvic lymph node dissection for prostate cancer: a reassessment. Urology. 1995;46:352–5.
Disclosures
K. Keegan: none. Dr. Michael Cookson has served as a consultant for Endo Pharmaceuticals.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Keegan, K.A., Cookson, M.S. Complications of Pelvic Lymph Node Dissection for Prostate Cancer. Curr Urol Rep 12, 203–208 (2011). https://doi.org/10.1007/s11934-011-0179-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11934-011-0179-z