MP47-11 EXTENDED PELVIC LYMPH NODE DISSECTION FOR INTERMEDIATE-HIGH RISK PROSTATE CANCER: FREQUENCY AND DISTRIBUTION OF NODAL METASTASES.

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV1 Apr 2017MP47-11 EXTENDED PELVIC LYMPH NODE DISSECTION FOR INTERMEDIATE-HIGH RISK PROSTATE CANCER: FREQUENCY AND DISTRIBUTION OF NODAL METASTASES. Marco Roscigno, Maria Nicolai, Richard LJ Naspro, Federico Pellucchi, Laura B Cornaghi, Daniela Chinaglia, Antonino Saccà, and Luigi F Da Pozzo Marco RoscignoMarco Roscigno More articles by this author , Maria NicolaiMaria Nicolai More articles by this author , Richard LJ NasproRichard LJ Naspro More articles by this author , Federico PellucchiFederico Pellucchi More articles by this author , Laura B CornaghiLaura B Cornaghi More articles by this author , Daniela ChinagliaDaniela Chinaglia More articles by this author , Antonino SaccàAntonino Saccà More articles by this author , and Luigi F Da PozzoLuigi F Da Pozzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1471AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard extended pelvic lymph node dissection (ePLND) included the removal of external iliac, obturator and internal iliac chains. However, mapping studies demostrated that extending template up to the ureteric crossing would remove approximately 75% of all primary landing sites, and suggested to add presacral node dissection to ePLND, in order to correctly remove nodal metastases in 97% of patients. The aim of this study is to describe the frequency and distribution of metastases to pelvic nodes, in patients (Pts) with clinically localised, intermediate-high risk prostate cancer (PCa) according to the EAU guidelines, treated with radical prostatectomy and ePLND. METHODS We retrospectively evaluated 554 consecutive Pts with clinically localized, intermediate-high risk PCa, treated with open radical prostatectomy and ePLND between 2009 and 2015 at a single institution by multiple experienced surgeons. The ePLND always consisted of the external iliac, obturator, internal iliac, presacral and common iliac nodal site up to the ureteric crossing. Specimens from each anatomic site were sent in separate packets. RESULTS The median number of removed nodes was 22 (range 9-61). Positive nodes (LN+) were found in 119 patients (21.4%). The mean and median number of positive nodes were 2.9 and 1 (range: 1-18), respectively. The median number of removed nodes was 6, 8, 5, 2, and 1 for external iliac, obturator, internal iliac, common iliac, and presacral site, respectively. Out of the 119 Pts, nodal metastases were found in 54 (45.4%), 50 (42%), 56 (47.1%), 12 (10.1%) and 15 (12.6%) in the external iliac, obturator, internal iliac, common iliac, and presacral sites, respectively. However, when analyzing the presence of positive nodes only in a single anatomic area, nodal metastases were present in 19 (16%), 18 (15.1%), 25 (21%), 0, and 3 (2%) in the external iliac, obturator, internal iliac, common iliac, and presacral site, respectively. A limited LND would have correctly staged 92 (77%) Pts and would have removed all LN+ in 37 (31%) Pts. An extended LND would have correctly staged 116 (97%) Pts but removed all LN+ in only 93 (78%) Pts. CONCLUSIONS Internal iliac and presacral nodes harbored metastases in more than 60% of cases, and positive nodes were present only in these areas in 23% of cases. On the contrary, metastases at common iliac nodes were always associated with concomitant involvement of external iliac, obturator and/or internal iliac nodes. An extended LND would have correctly staged 116 (97%) Pts but removed all LN+ in only 93 (78%) Pts. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e632 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marco Roscigno More articles by this author Maria Nicolai More articles by this author Richard LJ Naspro More articles by this author Federico Pellucchi More articles by this author Laura B Cornaghi More articles by this author Daniela Chinaglia More articles by this author Antonino Saccà More articles by this author Luigi F Da Pozzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...