771 SHOULD AN EXTENDED NODAL TEMPLATE FOR HIGH RISK PROSTATE CANCER ALWAYS INCLUDE REMOVAL OF COMMON ILIAC LYMPH NODES?

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2012771 SHOULD AN EXTENDED NODAL TEMPLATE FOR HIGH RISK PROSTATE CANCER ALWAYS INCLUDE REMOVAL OF COMMON ILIAC LYMPH NODES? Andrea Gallina, Alberto Briganti, Nazareno Suardi, Firas Abdollah, Umberto Capitanio, Fabio Castiglione, Federico Pellucchi, Paolo Capogrosso, Paolo Dell'Oglio, Alessandro Nini, Renzo Colombo, Giorgio Guazzoni, Patrizio Rigatti, and Francesco Montorsi Andrea GallinaAndrea Gallina Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Nazareno SuardiNazareno Suardi Milan, Italy More articles by this author , Firas AbdollahFiras Abdollah Milan, Italy More articles by this author , Umberto CapitanioUmberto Capitanio Milan, Italy More articles by this author , Fabio CastiglioneFabio Castiglione Milan, Italy More articles by this author , Federico PellucchiFederico Pellucchi Milan, Italy More articles by this author , Paolo CapogrossoPaolo Capogrosso Milan, Italy More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio Milan, Italy More articles by this author , Alessandro NiniAlessandro Nini Milan, Italy More articles by this author , Renzo ColomboRenzo Colombo Milan, Italy More articles by this author , Giorgio GuazzoniGiorgio Guazzoni Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.858AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The benefit of removal of common iliac lymph nodes at radical prostatectomy (RP) remains unclear. Nonetheless, the presence of positive common iliac lymph nodes may be associated with a worse prognosis. Our objective was to identify patients at a higher risk of harboring positive common iliac lymph nodes at surgery within a single tertiary care center. METHODS The study included a total of 136 patients who underwent RP and an extended pelvic lymphadenectomy (removal of obturator, hypogastric, external iliac, and common iliac lymph nodes) for intermediate- and high-risk prostate cancer as defined by D'Amico risk group classification at a single institution. All retrieved lymph nodes were sent for pathological assessement in multiple packages according to each landing site. Logistic regression analyses were used to assess the effect of the D'Amico risk classification for prediction of positive common iliac lymph nodes at RP. Finally, logistic regression analyses also assessed the rate of positive common iliac lymph nodes according to the presence of positive lymph nodes in the other landing sites examined (namely obturator, internal iliac, and external iliac) within each risk group. RESULTS Overall, 40 men (29%) had positive common iliac lymph nodes at RP. Overall, 54 (40%), and 82 (60%) patients were considered as intermediate- and high-risk according to the D' Amico classification, respectively. For the same groups, 11, and 40% of patients harbored positive common iliac lymph nodes. High-risk patients were significantly more likely to harbor positive common iliac lymph nodes relative to patients with intermediate-risk prostate cancer (odds ratio [OR]: 5.7, p<0.001). Moreover, 24 and 57%, 24 and 50%, 2 and 18% harbored metastases in the obturator, external iliac, and internal iliac lymph nodes within intermediate and high-risk patients, respectively. In high-risk patients, patients with positive internal iliac, external iliac, or obturator lymph nodes were 7-, 5-, and 4-fold more likely to harbor metastases in the common iliac lymph nodes (all p¡Ü0.006). In contrast, no difference was recorded within intermediate-risk patients (all p>0.05). CONCLUSIONS An extended pelvic lymphadenectomy with removal of common iliac lymph nodes should be considered only in high-risk prostate cancer with nodal disease in other landing sites. In these patients, intraoperative frozen section might be considered in order to assess the need for extending lymphadenectomy to common iliac lymph nodes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e315 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Gallina Milan, Italy More articles by this author Alberto Briganti Milan, Italy More articles by this author Nazareno Suardi Milan, Italy More articles by this author Firas Abdollah Milan, Italy More articles by this author Umberto Capitanio Milan, Italy More articles by this author Fabio Castiglione Milan, Italy More articles by this author Federico Pellucchi Milan, Italy More articles by this author Paolo Capogrosso Milan, Italy More articles by this author Paolo Dell'Oglio Milan, Italy More articles by this author Alessandro Nini Milan, Italy More articles by this author Renzo Colombo Milan, Italy More articles by this author Giorgio Guazzoni Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...