Limited Pelvic Lymph Node Dissection Research Articles

Fluorescence in prostate cancer surgery

Prostate cancer is different from many other solid tumours, mainly because of its multifocal growth pattern, which precludes a conservative approach during surgery. 1 Mottet N van den Bergh RCN Briers E et al. EAU-EANM-ESTROESUR-SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021; 79: 243-262 Summary Full Text Full Text PDF PubMed Scopus (931) Google Scholar Moreover, even when spread to the locoregional lymph nodes, it cannot always be clearly identified during surgery. This has led to two different surgical management scenarios. For organ-confined disease, the inability to identify the boundaries of the tumour within the gland makes the radical excision of the gland necessary, which has a substantial effect on patients’ postoperative functional outcomes and leading to a not negligible rate of positive surgical margins. 2 Lane JA Donovan JL Davis M et al. Active monitoring, radical prostatectomy, or radiotherapy for localised prostate cancer: study design and diagnostic and baseline results of the ProtecT randomised phase 3 trial. Lancet Oncol. 2014; 15: 1109-1118 Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar For locally advanced disease involving locoregional lymph nodes, the inability to intraoperatively identify metastatic lymph nodes has limited the role of extended pelvic lymph node dissection to a staging procedure. 3 Lestingi JFP Guglielmetti GB Trinh QD et al. Extended versus limited pelvic lymph node dissection during radical prostatectomy for intermediate- and high-risk prostate cancer: early oncological outcomes from a randomized phase 3 trial. Eur Urol. 2021; 79: 595-604 Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar First-in-patient study of OTL78 for intraoperative fluorescence imaging of prostate-specific membrane antigen-positive prostate cancer: a single-arm, phase 2a, feasibility trialThis first-in-patient study showed that OTL78 was well tolerated and had the potential to improve prostate cancer detection. Optimal dosing was 0·03 mg/kg, 24 h preoperatively. PSMA-directed fluorescence imaging allowed real-time identification of visually occult prostate cancer and might help to achieve complete oncological resections. Full-Text PDF

Editorial Comment.

No AccessJournal of UrologyAdult Urology13 Apr 2023Editorial CommentThis article comments on the following:Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imaging–targeted Biopsy: A Study That Challenges the Dogmais a letter which has replyReply by Authors Christoph Würnschimmel, Philipp Baumeister, and Agostino Mattei Christoph WürnschimmelChristoph Würnschimmel Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland Faculty of Medicine and Health Sciences, University of Lucerne, Lucerne, Switzerland More articles by this author , Philipp BaumeisterPhilipp Baumeister Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland Faculty of Medicine and Health Sciences, University of Lucerne, Lucerne, Switzerland More articles by this author , and Agostino MatteiAgostino Mattei Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland Faculty of Medicine and Health Sciences, University of Lucerne, Lucerne, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003442.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol.2006; 50(5):1006-1013. Crossref, Medline, Google Scholar 2. Unilateral pelvic lymph node dissection in prostate cancer patients diagnosed in the era of magnetic resonance imaging–targeted biopsy: a study that challenges the dogma. J Urol2023; 210(1):000-000. Google Scholar 3. The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol.2008; 53(1):118-125. Crossref, Medline, Google Scholar 4. Extended versus limited pelvic lymph node dissection during radical prostatectomy for intermediate- and high-risk prostate cancer: early oncological outcomes from a randomized phase 3 trial. Eur Urol.2021; 79(5):595-604. Crossref, Medline, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology13 Apr 2023Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imaging–targeted Biopsy: A Study That Challenges the DogmaJournal of Urology13 Apr 2023Reply by Authors Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christoph Würnschimmel Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland Faculty of Medicine and Health Sciences, University of Lucerne, Lucerne, Switzerland More articles by this author Philipp Baumeister Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland Faculty of Medicine and Health Sciences, University of Lucerne, Lucerne, Switzerland More articles by this author Agostino Mattei Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland Faculty of Medicine and Health Sciences, University of Lucerne, Lucerne, Switzerland More articles by this author Expand All Advertisement PDF downloadLoading ...

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Extended pelvic lymph node dissection in muscle invasive bladder cancer.

Bilateral pelvic lymph node dissection (PLND) at the time of radical cystectomy (RC) provides important staging information and oncologic benefit in patients with bladder cancer. The optimal extent of the PLND remains controversial. Our aim is to highlight nodal mapping studies and the data that guides optimization of both staging and oncologic outcomes. We then review contemporary randomized trials studying the extent of PLND. A recent randomized trial (RCT) powered for a 15% improvement in recurrence-free survival (RFS) of extended (e) over limited (l)PLND was completed but failed to identify this large difference in outcome. Concerns over study design limit the ability to interpret the oncologic results. Importantly, ePLND minimally changed surgical morbidity. An ongoing, similar RCT (SWOG S1011) powered to detect a 10% difference in RFS has completed accrual, but no published outcomes are available. RC and ePLND can provide cure in 33% of LN positive bladder cancer patients. Current data support a 5% improvement in RFS if ePLND is routinely used in MIBC patients. Two randomized trials powered to identify much larger (15 and 10%) improvements in RFS are unlikely to identify such an ambitious benefit by extending the PLND.

Different lymph node dissection ranges during radical prostatectomy for patients with prostate cancer: a systematic review and network meta-analysis

ObjectiveThe purpose of this network meta-analysis was to compare the effectiveness and adverse effects of limited, standard, extended, and super-extended pelvic lymph node dissection (PLND) following radical prostatectomy.MethodsThis study followed the PRISMA 2020 statement. Clinical trials were searched from three electronic databases, including PubMed, the Cochrane Library, and Embase from the database’s inception to April 5, 2022. The lymph node-positive rate, biochemical recurrence-free rate, lymphocele rate, thromboembolic rate, and overall complication rate were compared by meta-analysis. Data analyses were performed using R software based on the Bayesian framework.ResultsSixteen studies involving 15,269 patients were included. All 16 studies compared the lymph node-positive rate; 5 studies compared the biochemical recurrence-free rate; 10 studies compared the lymphocele rate; 6 studies compared the thromboembolic rate, and 9 studies compared the overall complication rate. According to Bayesian analysis, the lymph node-positive rate, lymphocele rate, and overall complication rate were significantly associated with the extension of the PLND range. The limited, extended, and super-extended PLND templates showed a similar but lower biochemical recurrence-free rate and a higher thromboembolic rate than the standard template.ConclusionsThe extension of the PLND range is associated with an elevated lymph node-positive rate; however, it does not improve the biochemical recurrence-free rate and correlates with an increased risk of complications, especially lymphocele. The selection of the PLND range in clinical practice should consider the oncological risk and adverse effects.Trial registrationPROSPERO (CRD42022301759).

Clinical significance of limited and extended pelvic lymph node dissection during robot-assisted radical prostatectomy for patients with localized prostate cancer: A retrospective, propensity score matching analysis.

We investigated the diagnostic and therapeutic benefits of limited or extended pelvic lymph node dissection during a robot-assisted radical prostatectomy for localized prostate cancer. Diagnostic and therapeutic benefits were assessed according to the rates of pN1 and biochemical recurrence, respectively. The primary outcome was the biochemical recurrence-free rate, and secondary outcomes included the diagnostic and therapeutic benefits of pelvic lymph node dissection. A total of 534 patients were analyzed. Out of the 534 patients, 207 (38.8%) received limited pelvic lymph node dissection while 134 (25.1%) received extended dissection. There were 297 patients with a Briganti index ≥5%. Extended dissections yielded significantly more resected lymph nodes (p < 0.0001), and 72.2% of cases of pN1 were located outside the obturator. The incidence rate of pN1 was 6.1%, and performance of extended lymph node dissection was an independent predictor for pN1 (odds ratio 9.0, 95% confidence interval 2.5-33.1). The rate of biochemical recurrence was 14.9%, and Cox proportional hazards regression analysis of the propensity score matched population revealed that patients with high or very-high risk tended to benefit from limited lymph node dissection (hazard ratio 8.4, 95% confidence interval 0.8-82.3) while the therapeutic benefit of extended dissection was unclear by comparison. Extended pelvic lymph node dissection significantly improves diagnostic accuracy; however, the therapeutic benefit of pelvic lymph node dissection was not observed in this study.

Significance of pelvic lymph node dissection during radical prostatectomy in high-risk prostate cancer patients receiving neoadjuvant chemohormonal therapy

We aimed to determine the survival and staging benefit of limited pelvic lymph node dissection (PLND) during radical prostatectomy (RP) in high-risk prostate cancer (PC) patients treated with neoadjuvant chemohormonal therapy. We retrospectively analyzed 516 patients with high-risk localized PC (< cT4N0M0) who received neoadjuvant androgen-deprivation therapy plus estramustine phosphate followed by RP between January 2010 and March 2020. Since we stopped limited PLND for such patients in October 2015, we compared the surgical outcomes and biochemical recurrence-free survival (BCR-FS) between the limited-PLND group (before October 2015, n = 283) and the non-PLND group (after November 2015, n = 233). The rate of node metastases in the limited-PLND group were 0.8% (2/283). Operation time was significantly longer (176 vs. 162 min) and the rate of surgical complications were much higher (all grades; 19 vs. 6%, grade ≥ 3; 3 vs. 0%) in the limited-PLND group. The inverse probability of treatment weighting-Cox analysis revealed limited PLND had no significant impact on BCR-FS (hazard ratio, 1.44; P = 0.469). Limited PLND during RP after neoadjuvant chemohormonal therapy showed quite low rate of positive nodes, higher rate of complications, and no significant impact on BCR-FS.

MP50-11 EXTENDED VERSUS LIMITED PELVIC LYMPH NODE DISSECTION YIELDS NO DIFFERENCES IN 3-YEAR DISEASE FREE RATES

INTRODUCTION AND OBJECTIVE:Extended pelvic lymph node dissection (ePLND) increases detection rate of lymph node positive prostate cancer compared to limited pelvic lymph node dissection (lPLND); im...

When the limited pelvic lymph node dissection in prostate cancer patients can be justified?

When the limited pelvic lymph node dissection in prostate cancer patients can be justified?

Prediction of the Need for an Extended Lymphadenectomy at the Time of Radical Cystectomy in Patients with Bladder Cancer

BackgroundA prospective randomized trial (LEA AUO AB 25/02) found no survival benefit in extended compared with limited pelvic lymph node dissection (PLND) templates in bladder cancer (BCa) patients treated with radical cystectomy (RC). However, the rate of lymph node invasion (LNI) in the standard and extended templates was lower than estimated. ObjectiveTo assess the accuracy of preoperative clinical and pathological parameters to predict LNI and to develop a model to preoperatively select candidates for the extended PLND templates. Design, setting, and participantsA total of 903 BCa patients treated at a single institution were retrospectively identified. The primary outcome was to identify preoperatively the risk of LNI to tailor the type of PLND. The extended PLND templates consisted in the removal of pelvic lymph nodes together with the common iliac, presacral, para-aortocaval, interaortocaval, and paracaval sites up to the inferior mesenteric artery. InterventionA total of 903 BCa patients were treated with RC and bilateral extended PLND templates. Outcome measurements and statistical analysisSeveral models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots and decision curve analyses. A nomogram predicting LNI in the extended pattern was developed and validated internally. Results and limitationsOverall, 55 patients (6.1%) had LNI in the extended PLND templates at RC. The median number of nodes removed was 19 (interquartile range: 13–26). A model including age, clinical T stage, clinical node stage, lymphovascular invasion, and presence of carcinoma in situ at the last transurethral resection before RC was developed. The AUC of this model is 73%. Using a cutoff of 3%, 108 extended PLNDs (12%) would be spared and only two LNIs (3%) would be missed. The main limitations of our model are the retrospective nature of the data, lack of external validation, and low rate of LNI. ConclusionsThis is the first proposed model to predict LNI in the extended PLND templates. This model might help urologists identify which patients might benefit from an extended PLND at the time of RC, reserving a standard PLND for all the others. Patient summaryWe developed the first nomogram to predict lymph node invasion (LNI) in the extended pelvic lymph node dissection templates in bladder cancer patients treated with radical cystectomy. The adoption of our model to identify candidates for the extended pelvic lymph node dissection templates could avoid up to 12% of these procedures at the cost of missing only 3% of patients with LNI.

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

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.

MP67-13 COMPARISON OF MORBIDITY BETWEEN LIMITED AND EXTENDED PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER: RESULTS FROM A LARGE, CLINICALLY-INTEGRATED, RANDOMIZED TRIAL

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP67)1 Apr 2020MP67-13 COMPARISON OF MORBIDITY BETWEEN LIMITED AND EXTENDED PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER: RESULTS FROM A LARGE, CLINICALLY-INTEGRATED, RANDOMIZED TRIAL Karim Touijer, Daniel D. Sjoberg, Nicole Benfante, Claudia Mercader Barrull*, Natalia Picola Brau, Inés Rivero Belenchón, Vincent Laudone, Behfar Ehdaie, James A. Eastham, Peter T. Scardino, and Andrew Vickers Karim TouijerKarim Touijer More articles by this author , Daniel D. SjobergDaniel D. Sjoberg More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Claudia Mercader Barrull*Claudia Mercader Barrull* More articles by this author , Natalia Picola BrauNatalia Picola Brau More articles by this author , Inés Rivero BelenchónInés Rivero Belenchón More articles by this author , Vincent LaudoneVincent Laudone More articles by this author , Behfar EhdaieBehfar Ehdaie More articles by this author , James A. EasthamJames A. Eastham More articles by this author , Peter T. ScardinoPeter T. Scardino More articles by this author , and Andrew VickersAndrew Vickers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000947.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic lymph node dissection (PLND) in prostate cancer is controversial. Although it represents the most reliable procedure for lymph node staging, the extended PLND was reported to be associated with increased morbidity. METHODS: Between October 2011 and March 2017, men were consented to the trial and underwent radical prostatectomy at Memorial Sloan Kettering Cancer Center. The study design was a cluster randomization with crossover. Each surgeon was randomized to use a limited (external iliac nodal packet) vs. extended (external iliac, obturator fossa and hypogastric nodal packets) PLND template for a 3-month period. At the end of the 3-month period, surgeons were once again randomized. Morbidity data within 30 days of surgery was prospectively graded and collected in the clinical research database. RESULTS: A total of 1574 patients were randomized: 811 randomized to the extended and 763 to the limited template. Overall the rate of complication was 10.5% in the limited PLND group vs. 8.5% in the extended PLND group. There were no grade IV or V complications. Rates for grade II and III complications were similar (7.2% in limited vs. 6.3% in extended). CONCLUSIONS: In this large randomized trial the overall rate of grade II and III complications was low. There was no significant difference in complication rates between the limited and extended PLND. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1030-e1030 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karim Touijer More articles by this author Daniel D. Sjoberg More articles by this author Nicole Benfante More articles by this author Claudia Mercader Barrull* More articles by this author Natalia Picola Brau More articles by this author Inés Rivero Belenchón More articles by this author Vincent Laudone More articles by this author Behfar Ehdaie More articles by this author James A. Eastham More articles by this author Peter T. Scardino More articles by this author Andrew Vickers More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-09 BIOCHEMICAL RECURRENCE AND OVERALL SURVIVAL IN MEN WITH HIGH-RISK PROSTATE CANCER UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH LIMITED VS. EXTENDED PELVIC LYMPH NODE DISSECTION

INTRODUCTION AND OBJECTIVE:Extended pelvic lymph node dissection (eLND) at the time of radical prostatectomy has a staging benefit over limited pelvic lymph node dissection (LLND) but an unclear th...

Extended vs Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediate- and High-Risk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Trial

Background: The role of extended pelvic lymph node dissection (EPLND) in the surgical management of prostate cancer (PCa) patients remains controversial, mainly because of lack of randomized controlled trials (RCT). Methods: In this randomized controlled phase 3 study, men with newly diagnosed clinically localized intermediate- or high-risk PCa who had chosen surgery as their treatment approach were enrolled from Sao Paulo State Cancer Institute, Brazil. Participants were randomly assigned (1:1) to have either extended (EPLND) or limited pelvic lymph node dissection (LPLND) at radical prostatectomy (RP). LPLND included the obturator chain bilaterally, whereas EPLND involved included obturator, external-, internal-, common-iliac and pre-sacral chains bilaterally. The primary endpoint was biochemical recurrence-free survival (BRFS) and the secondary outcomes were metastasis-free survival (MFS), cancer-specific survival (CSS) and histopathologic findings. This trial was registered with ClinicalTrials.gov, number NCT01812902. Findings: Between May 2012 and December 2016, 300 men were enrolled, of which 150 were randomly assigned to EPLND and 150 to LPLND. Median follow-up was 54.3 months. EPLND detected 4.9 times more lymph node metastases (16.8% [n=25] in the EPLND group vs. 3.4% [n=5] in the LPLND group, p<0.001). The median BRFS was 61.4 months in the LPLND group and not reached in the EPLND group (HR 0.91; 95% CI 0.63-1.32; p=0.623). The median metastasis-free survival was not reached in both groups (HR 0.57; 95% CI 0.17-1.8; p=0.345). CSS data were not available because no patient died from prostate cancer prior to the cutoff date. In exploratory subgroup analysis, patients with preoperative biopsy International Society of Urological Pathology (ISUP) grades 3-5 who were allocated to EPLND had improved BRFS (HR 0.33, 95% CI 0.14-0.74, interaction p<0.001). Interpretation: EPLND is not associated with an improvement in biochemical recurrence among men undergoing RP for intermediate- and high-risk localized PCa. Subgroup analyses suggest that preoperative ISUP 3, 4 or 5 biopsy is associated with an improvement in BRFS for patients undergoing EPLND. Trial Registration Number: This trial was registered with ClinicalTrials.gov, number NCT01812902. Funding: Foundation for Research Support of the State of Sao Paulo (FAPESP). Declaration of Interest: Lestingi, Coelho, Pontes, Faraj, Mitre, Cordeiro, Srougi, Nahas: none. Guglielmetti: Personal fees from Janssen; outside the submitted work. Trinh: Personal fees from Astellas, Bayer, InsighTec and Janssen. Grants from Intuitive Surgical; outside the submitted work. Bastos: Grants from Janssen and Astellas; outside the submitted work. Sarkis: Personal fees from Ferring and from MSD - Merck Sharp and Dohme; outside the submitted work. Ethical Approval: All patients participating in the study will sign the ICF and study was approved by the local Research Ethics Committee.

Pelvic lymph node dissection during radical cystectomy for muscle-invasive bladder cancer.

Radical cystectomy is the gold-standard treatment option for muscle-invasive and metastatic bladder cancer. At the time of cystectomy, up to 25% of patients harbour metastatic lymph node deposits. These deposits most frequently occur in the obturator fossa, but can be as proximal as the interaortocaval region. Thus, the use of concurrent pelvic lymph node dissection (PLND) with cystectomy has been increasingly reported. Data from studies including many patients suggest substantial oncological benefit in PLND cohorts versus non-PLND cohorts, irrespective of pathological nodal status. Additionally, PLND provides useful prognostic information, including disease burden, lymph node density, and extracapsular extension of metastatic lymph nodes. Accordingly, the National Comprehensive Cancer Network guidelines advocate the use of PLND during radical cystectomy for muscle-invasive bladder cancer. Despite this recommendation, a lack of consensus exists regarding the optimal PLND template. Comparative series suggest that extended PLND provides improved recurrence-free survival and cancer-specific survival compared with more limited PLND templates. More extensive templates (such as super-extended PLND) provide no additional survival benefit at the potential cost of increased operative time and patient morbidity. In addition to extended PLND templates, increased nodal harvest confers an oncological benefit in patients with node-positive disease or in patients with node-negative disease. Accordingly, recommendations for a minimum nodal yield have been proposed. Despite the growing body of evidence, formal recommendations by oncological and urological authoritative bodies have been limited owing to the lack of randomized data and level I evidence.

Extended pelvic lymph-node dissection and radiotherapy with curative intent in high-risk lymph-node-positive prostate cancer: a possible curative strategy?

Objective: This study evaluated the outcome with a treatment strategy for high-risk prostate cancer (PCa) using extended pelvic lymph-node dissection (eLND) followed by external beam radiation therapy (EBRT) in lymph-node-positive (LNpos) and lymph-node-negative (LNneg) cases compared with the strategy with limited pelvic lymph-node dissection (lLND) and only giving EBRT to LNneg cases.Materials and methods: From 2000 to 2006, 124 men with high-risk PCa underwent lLND and initiated androgen deprivation therapy (ADT) before planned EBRT. LNpos patients were excluded from EBRT following the SPCG-7 study strategy (group I). From 2007 to 2013, 111 patients underwent eLND and started ADT before EBRT, and LNneg and most LNpos patients received EBRT (group II). Using Kaplan–Meier plots and multivariable Cox regression, biochemical recurrence-free, metastasis-free, cancer-specific survival and overall survival were compared during a 10 year follow-up.Results: PSA progression-free survival rates after 2, 4, 6, 8 and 10 years were 78%, 66%, 52%, 45% and 41% in group I, and 88%, 83%, 78%, 69% and 69% in group II (p < 0.001), respectively. Group II had a lower risk of PSA progression [hazard ratio (HR) = 0.43, 95% confidence interval (CI) 0.27,0.69, p = 0.001], metastasis development (HR = 0.51, 95% CI 0.27,0.97, p = 0.040) and overall mortality (HR = 0.49, 95% CI 0.26,0.92, p = 0.027), but not of PCa-specific death (HR = 0.45, 95% CI 0.19,1.08, p = 0.074).Conclusion: A treatment strategy for high-risk PCa with eLND combined with EBRT in LNneg and LNpos cases may improve outcome compared to a strategy with lLND and offering EBRT only to LNneg cases but ADT to LNpos cases.

Extended versus Standard Pelvic Lymph Node Dissection in Radical Prostatectomy on Oncological and Functional Outcomes: A Systematic Review and Meta-Analysis.

We evaluated the effect of the extent of pelvic lymph node dissection (PLND) on oncological and functional outcomes in patients with intermediate- to high-risk prostate cancer (PCa) by conducting a systematic review and meta-analysis. Two independent researchers performed a systematic review of radical prostatectomy (RP) with extended PLND (ePLND), and RP with standard (sPLND) or limited PLND (lPLND) in patients with PCa using the PubMed, EMBASE, and Cochrane Library databases and using the terms 'prostatectomy', 'lymph node excision', and 'prostatic neoplasm'. The primary outcome was biochemical-free survival, which was analyzed by extracting survival data from the published Kaplan-Meier (KM) curves. In addition, we obtained summarized survival curves by reconstructing the KM data. Secondary outcomes of the recovery of erection and continence were also analyzed. Nine studies involving over 1554 patients were included, one of which was a randomized controlled trial. The pooled analysis showed a significant difference in biochemical recurrence between ePLND and sPLND (hazard ratio 0.71, 95% confidence interval 0.56-0.90, p=0.005), with no significant between-study heterogeneity (I 2=37%). From the summary survival curves, it can be observed that the curves for the two groups diverged more and more as a function of time. From the analyses of functional outcomes including only three studies, no statistically significant differences in the recovery of erectile function and continence were observed. No evidence of significant publication bias was found. In patients with PCa, ePLND could be an oncological benefit; however, a functional compromise cannot be determined.

Lymph node yield in node-negative patients predicts cancer specific survival following radical cystectomy for transitional cell carcinoma.

PurposeTo determine the oncological implications of increased nodal dissection in node-negative bladder cancer during radical cystectomy in a contemporary Australian series.Materials and MethodsWe performed a multicenter retrospective study, including more than 40 surgeons across 5 sites over a 10-year period. We identified 353 patients with primary bladder cancer undergoing radical cystectomy. Extent of lymphadenectomy was defined as follows; limited pelvic lymph node dissection (PLND) (perivesical, pelvic, and obturator), standard PLND (internal and external iliac) and extended PLND (common iliac). Multivariable cox proportional hazards and logistic regression models were used to determine LNY effect on cancer-specific survival.ResultsOver the study period, the extent of dissection and lymph node yield increased considerably. In node-negative patients, lymph node yield (LNY) conferred a significantly improved cancer-specific survival. Compared to cases where LNY of 1 to 5 nodes were taken, the hazard ratio (HR) for 6 to 15 nodes harvested was 0.78 (95% confidence interval [CI], 0.43–1.39) and for greater than 15 nodes the HR was 0.31 (95% CI, 0.17–0.57), adjusted for age, sex, T stage, margin status, and year of surgery. The predicted probability of cancer-specific death within 2 years of cystectomy was 16% (95% CI, 13%–19%) with 10 nodes harvested, falling to 5.5% (95% CI, 0%–12%) with 30 nodes taken. Increasing harvest in all PLND templates conferred a survival benefit.ConclusionsThe findings of the current study highlight the improved oncological outcomes with increased LNY, irrespective of the dissection template. Further prospective research is needed to aid LND data interpretation.

Limited versus extended pelvic lymphadenectomy in patients with bladder cancer undergoing radical cystectomy: Survival results from a prospective, randomized trial (LEA AUO AB 25/02).

4503Background: The extent of pelvic lymph node dissection (PLND) in bladder cancer patients (pts.) undergoing radical cystectomy may affect survival according to retrospective studies. The German Urologic Oncology Group (AUO) reports mature data of the first prospective, randomized clinical trial to evaluate the impact of a limited versus an extended PLND. Methods: Pts. with high-grade T1 or invasive urothelial bladder cancer (cT2-T4a) from 16 German centers were randomized 1:1 to receive a limited versus an extended PLND at the time of radical cystectomy. Limited PLND included 6 fields (bilateral obturator, internal and external iliac nodes) and extended PLND defined 14 fields (in addition bilateral deep obturator fossa, presacral, paracaval, interaortocaval and paraaortal nodes up to the inferior mesenteric artery). Pts. with neoadjuvant chemo- or radiotherapy were excluded, adjuvant chemotherapy was allowed. The primary endpoint was recurrence-free survival (RFS). Cancer-specific survival (CSS) was a ...

Editorial Comment

No AccessJournal of UrologyAdult Urology1 Aug 2016Editorial Comment Bertram Yuh Bertram YuhBertram Yuh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2994AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 196(2), pp. 512–513 References 1 : Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effect on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis. World J Urol2015; . Epub ahead of print. Google Scholar 2 : The impact of magnetic resonance imaging on prediction of extraprostatic extension and prostatectomy outcome in patients with low-, intermediate- and high-risk prostate cancer: try to find a standard. J Endourol2015; 29: 1396. Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 196Issue 2August 2016Page: 512-513 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bertram Yuh More articles by this author Expand All Advertisement PDF downloadLoading ...