Lymph Node Dissection in Prostate Cancer Surgery

Abstract

Lymph node dissection performed during radical prostatectomy is the gold standard for determining lymph node invasion (LNI) in patients with prostate cancer. The role of pelvic lymph node dissection in patients with low-, intermediate-, and high-risk prostate cancer has been evaluated in depth to determine the need for lymph node removal, as well as the extent of how aggressively lymph nodes should be dissected in these patients. While imaging has not played a significant role in determining LNI in prostate cancer in the past, recent advances in PET/CT, MRI, and sentinel lymph node dissection have provided another modality to identify lymph node metastases with increasing success. Many studies have been done to evaluate the preoperative variables that can be used to predict the likelihood of lymph node invasion and determine nomograms for when pelvic lymph node dissection (PLND) should be performed and whether that dissection should be limited or extended. Despite these studies, no one predictive model has been established as the gold standard, and multiple models are used in clinical practice today. The role of PLND and its effect on outcomes in prostate cancer patients has also been studied. It has been suggested that removal of lymph nodes in some cases of prostate cancer may improve clinical outcomes, decrease biochemical recurrence, and increase long-term survival rates. The introduction of minimally invasive surgery, particularly the use robotic-assisted radical prostatectomy (RARP), has raised further questions about when PLND should be performed. The comparison of outcomes of PLND in RARP versus open prostatectomy has generated new questions about what the standard for PLND should entail.