MP69-08 AN ANALYSIS OF THE MORBIDITY OF LIMITED, EXTENDED, AND SUPER-EXTENDED PELVIC LYMPHADENECTOMY TEMPLATES DURING RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2016MP69-08 AN ANALYSIS OF THE MORBIDITY OF LIMITED, EXTENDED, AND SUPER-EXTENDED PELVIC LYMPHADENECTOMY TEMPLATES DURING RADICAL PROSTATECTOMY Vidit Sharma, Alessandro Morlacco, Jason E Joseph, Avinash K Nehra, Matthew K Tollefson, R. Houston Thompson, Stephen A Boorjian, Igor Frank, Matthew T Gettman, and R. Jeffrey Karnes Vidit SharmaVidit Sharma More articles by this author , Alessandro MorlaccoAlessandro Morlacco More articles by this author , Jason E JosephJason E Joseph More articles by this author , Avinash K NehraAvinash K Nehra More articles by this author , Matthew K TollefsonMatthew K Tollefson More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Stephen A BoorjianStephen A Boorjian More articles by this author , Igor FrankIgor Frank More articles by this author , Matthew T GettmanMatthew T Gettman More articles by this author , and R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1386AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of pelvic lymphadenectomy (PLND) templates on operative complications and functional outcomes during radical prostatectomy (RP) remains understudied. Here we analyze a large single institution series to determine the relationship between PLND templates, complications and functional outcomes after RP. METHODS Years 2001 to 2013 of a prospectively maintained single institution RP registry were queried for NCCN intermediate and high risk PCa patients undergoing PLND. Patients received 1 of 4 possible PLND templates: 1) obturator alone; 2) obturator + external iliac; 3) obturator + external iliac + hypogastric (ePLND); and 4) common iliac + ePLND (super-ePLND). Descriptive statistics and multivariate logistic regression models were used to compare rates of complications, 1-yr potency (erections with our without medications) and 1-yr incontinence (1 or more pads per day) across PLND templates. RESULTS Out of 2,962 RPs, there were 735 (24.8%) obturator PLNDs, 574 (19.4%) obturator + external PLNDs, 1501 (50.7%) ePLNDs, and 152 (5.1%) super-ePLNDs. The overall complication rates were 20.6%, 26.5%, 24.5%, and 38.3%, respectively (p<0.001). The incidences of lymphedema (0.3%, 0.2%, 0.5%, 2.7% p=0.001) and lymphocele (1.6%, 1.7%, 2.7%, 6.3%, p=0.005) were significantly higher in the super-ePLND cohort. The groups did not differ significantly in terms of intra-operative complications (1.0%, 2.1%, 0.9%, 2.0%, p=0.089). Rates of venous thromboembolism also did not vary significantly (2.5%, 2.4%, 2.2%, 3.5% p=0.796). On multivariate logistic regression analysis (after adjusting for Age, BMI, pT stage, open vs robotic), only super-ePLND (OR 2.120, p<0.001) remained significantly associated with increased overall complications. At 1 year, potency (61.5%, 48.5%, 45.4%, and 44.8%, p<0.001) was lower and incontinence higher (5.6%, 11.6%, 10.5%, 12.3%, p<0.001) with wider PLND templates. After adjusting for nerve sparing status, age, BMI, open vs robotic, pT stage, adjuvant hormonal therapy, and adjuvant radiation: potency was no longer associated with PLND template (all p>0.05), however incontinence continued to be associated with wider PLND template (Odds ratio range 1.896-2.103, p<0.053). CONCLUSIONS A super-extended PLND was associated with increased overall complications, lymphedema and lymphoceles. An ePLND alone was not independently associated with these complications. Further investigation into the relationship between PLND template and incontinence is warranted. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e900 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Vidit Sharma More articles by this author Alessandro Morlacco More articles by this author Jason E Joseph More articles by this author Avinash K Nehra More articles by this author Matthew K Tollefson More articles by this author R. Houston Thompson More articles by this author Stephen A Boorjian More articles by this author Igor Frank More articles by this author Matthew T Gettman More articles by this author R. Jeffrey Karnes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...