Applied anatomy of pelvic lymph nodes and its clinical significance for prostate cancer:a single-center cadaveric study

Hong-Qi Shi,Yi-Yi Zhu,Jia-Jun Chen,Zai-Sheng Zhu

doi:10.1186/s12885-020-06833-1

Hong-Qi Shi, Yi-Yi Zhu + Show 2 more

Open Access

https://doi.org/10.1186/s12885-020-06833-1

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Abstract

BackgroundPelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP). Not only can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can also improve the prognosis of patients by eradicating micro-metastases. However, reports of the number of pelvic lymph nodes have generally come from incomplete dissection during surgery, there is no anatomic study that assesses the number and variability of lymph nodes. Our objective is to assess the utility of adopting the lymph node count as a metric of surgical quality for the extent of lymph node dissection during RP for prostate cancer by conducting a dissection study of pelvic lymph nodes in adult male cadavers.MethodsAll 30 adult male cadavers underwent pelvic lymph node dissection (PLND), and the lymph nodes in each of the 9 dissection zones were enumerated and analyzed.ResultsA total of 1267 lymph nodes were obtained. The number of lymph nodes obtained by limited PLND was 4–22 (14.1 ± 4.5), the number obtained by standard PLND was 16–35 (25.9 ± 5.6), the number obtained by extended PLND was 17–44 (30.0 ± 7.0), and the number obtained by super-extended PLDN was 24–60 (42.2 ± 9.7).ConclusionsThere are substantial inter-individual differences in the number of lymph nodes in the pelvic cavity. These results have demonstrated the rationality and feasibility of adopting lymph node count as a surrogate for evaluating the utility of PLND in radical prostatectomy, but these results need to be further explored.

Highlights

Pelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP)
The number of lymph nodes obtained by limited PLND was 4–22 (14.1 ± 4.5, coefficient of variation (CV) 32.2%), by standard PLND (s-PLND) was 16–35 (25.9 ± 5.6, CV 21.5%), by extended PLND (e-PLND) was 17–44 (30.0 ± 7.0, CV 23.3%) and by super-extended PLDN was 24–60 (42.2 ± 9.7, CV 23.1%) (Fig. 3)
PLND before RP has been considered to be of great significance in the diagnosis of prostate cancer, and the therapeutic value of PLND has been gradually valued in recent years [7, 8]

Summary

Introduction

Pelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP). Can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can improve the prognosis of patients by eradicating micro-metastases. Reports of the number of pelvic lymph nodes have generally come from incomplete dissection during surgery, there is no anatomic study that assesses the number and variability of lymph nodes. Can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can improve the prognosis of patients by eradicating micrometastases [1,2,3]. The purpose of this study was to investigate the utility of adopting the lymph node count as a criterion to evaluate PLND during RP by dissecting and observing 30 adult male human cadaver specimens and counting the lymph nodes

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Conclusion