Reply

Abstract

Pelvic lymph node dissection (PLND) is performed simultaneously with radical prostatectomy (RP) in patients with prostate cancer to detect possible lymph node (LN) metastasis. However, PLND is typically not performed in patients with low-grade (Gleason score ≤ 6) and low-stage (≤ cT2) prostate cancer, as LN metastasis occurs in < 2% of these patients, 1 Partin A.W. Kattan M.W. Subong E.N. et al. Combination of prostate-specific antigen, clinical state, and Gleason score to predict pathological stage of localized prostate cancer: a multi-institutional study. JAMA. 1997; 277: 1445-1451 Crossref PubMed Google Scholar and lymphocele develops as a postoperative complication in < 10% of patients after PLND. 2 Musch M. Klevecka V. Roggenbuck U. et al. Complications of pelvic lymphadenectomy in 1380 patients undergoing radical retropubic prostatectomy between 1993 and 2006. J Urol. 2008; 179: 923-928 Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar , 3 Pepper R.J. Pati J. Kaisary A.V. The incidence and treatment of lymphoceles after radical retropubic prostatectomy. BJU Int. 2005; 95: 772-775 Crossref PubMed Scopus (52) Google Scholar , 4 Augustin H. Hammerer P. Graefen M. et al. Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: Results of a single center between 1999 and 2002. Eur Urol. 2003; 43: 113-118 Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar The symptoms of lymphocele include pelvic pain, leg pain, leg edema, and hydronephrosis. Nonetheless, the therapeutic efficacy of PLND is well known in patients with prostate cancer, and several studies report long-term survival for patients with LN positive prostate cancer treated with RP and PLND. 5 Steinberg G.D. Epstein J.I. Piantadosi S. et al. Management of D1 adenocarcinoma of the prostate; the Johns Hopkins experience 1974-1987. J Urol. 1990; 144: 1425-1432 PubMed Google Scholar , 6 Daneshmand S. Queck M.L. Stein J.P. et al. Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long term results. J Urol. 2004; 172: 2252-2255 Abstract Full Text Full Text PDF PubMed Scopus (267) Google Scholar , 7 Pound C.R. Partin A.W. Epstein J.I. et al. Prostate-specific antigen after anatomic radical retropubic prostatectomy: patterns of recurrence and cancer control. Urol Clin North Am. 1997; 24: 395-406 Abstract Full Text Full Text PDF PubMed Scopus (533) Google Scholar However, long-term survival rates are decreased in patients having > 5 positive LNs detected in PLND. 6 Daneshmand S. Queck M.L. Stein J.P. et al. Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long term results. J Urol. 2004; 172: 2252-2255 Abstract Full Text Full Text PDF PubMed Scopus (267) Google Scholar Editorial CommentUrologyVol. 76Issue 2PreviewMany analogies have been drawn between prostate cancer and breast cancer.1 A surgical parallel that has not been considered previously, is the management of lymphorrhea after radical prostatectomy. These authors describe the use of octreotide, a potent analog of somatostatin, to reduce significant lymphorrhea after radical retropubic prostatectomy (RRP) and pelvic lymph node dissection (PLND), thereby reducing the morbidity of prolonged lymph drainage. Full-Text PDF