Lymphadenectomy For Prostate Cancer Research Articles

Robot-assisted salvage lymphadenectomy in prostate cancer with radiointerventional lymph note tagging

Prostate cancer is the second most common tumor in men worldwide, with lethality directly related to its staging. In general, radical prostatectomy represents the first line in the treatment of patients with prostate cancer, but even with improvements in diagnosis and advances in surgical techniques for the treatment of localized prostate cancer, it still occurs in up to 35% of cases. there will be biochemical recurrence over the years¹. Therefore, when this neoplasm recurs after the primary approach, treatment may vary according to its location and dissemination pattern. In cases of lymph node recurrence, adjunctive treatment with external radiotherapy is routinely indicated, associated or not with hormonal blockade.² However, in recent years, due to the advent of new imaging modalities with high sensitivity in cases of biochemical recurrence, the use of salvage lymphadenectomy has been proposed.² Thus, robotic salvage lymphadenectomy has emerged as an alternative to the treatment of patients with lymph node recurrence of prostate cancer. In this way, we seek to share, through a case report, the surgical technique of rescue lymphadenectomy with a lymph node marked by radiointervention. There are no conflicts of interest in this report.

Utility of Lymphadenectomy in Prostate Cancer: Where Do We Stand?

The purpose of this review is to summarize the current knowledge on lymph node dissection (LND) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP). Despite a growing body of evidence, the utility and therapeutic and prognostic value of such an approach, as well as the optimal extent of LND, remain unsolved issues. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, which limits the possibility of establishing clear recommendations. This indicates the need for further robust and adequately designed high-quality clinical trials.

Robot-assisted extended lymphadenectomy in prostate cancer.

The extent of lymph node dissection (LND) and its potential survival benefit are still a matter of debate. Aim of our review was to summarize the latest literature data regarding the surgical templates, the potential oncological benefits, the functional outcomes and the complications of extended lymph node dissection (eLND) during robot-assisted radical prostatectomy (RARP). We systematically reviewed all relevant studies using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) guidelines. A narrative synthesis of all relevant publications on surgical templates, complications, oncological and functional outcomes of robot assisted eLND was undertaken. A great deal of evidence supports that an extended template of LND is not only technically feasible but also safe in the context of RARP. It is really promising that in the era of minimally invasive surgery, parameters like the lymph node yield and the detection rates of positive lymph nodes during LND have become highly comparable with open series. The extended approach has already proved its benefits in terms of proper patient staging but more studies are needed with regard to functional outcomes and oncological benefits of this procedure.

PT083 - Salvage lymphadenectomy in prostate cancer

PT083 - Salvage lymphadenectomy in prostate cancer

Lymph node parameters and complications following laparoscopic extended pelvic lymphadenectomy for prostate cancer in 1000 consecutive patients

Objective: The purpose of this study was to investigate the short-term results of extended pelvic lymphadenectomy (ePLND) during laparoscopic radical prostatectomy (LRP). Patients and methods: Of 1330 consecutive patients undergoing LRP during a 90-month period 1000 (75%) had an ePLND for d’Amico intermediate- or high-risk prostate cancer. Results: Operating time, blood loss, conversion and transfusion rates and hospital stay were similar in patients having standard pelvic lymphadenectomy (sPLND) and ePLND. Median lymph node count was significantly greater following ePLND vs sPLND (17 vs 6; p⩽0.0001). Complication rates were also similar but trended ( p=0.06) towards a greater rate after ePLND vs sPLND: 9.0% and 5.5%. Lymph node involvement (LNI) was detected more frequently following ePLND in patients with: prostate specific antigen (PSA)=0–9.9 ( p=0.01) and PSA=10–19.9 ( p⩽0.0001); biopsy Gleason sum ⩽8 ( p⩽0.0001 to 0.03); intermediate- ( p⩽0.0001) and high-risk ( p⩽0.0001) cancer; pathological Gleason grade 7 ( p⩽0.0001) and pathological stage T3 ( p=0.0009 for pT3a and p⩽0.0001 for pT3b). Conclusion: ePLND is a more effective tool than sPLND in detecting LNI for patients in all prognostic clinical groups. This can be achieved without significant penalty with respect to operating time or complication rates.

Extended pelvic lymphadenectomy in prostate cancer: Practice makes perfect.

Extended pelvic lymphadenectomy in prostate cancer: Practice makes perfect.

Technique of Pelvic Lymphadenectomy After Robot-Assisted Laparoscopic Prostatectomy for Prostate Cancer

Pelvic lymphadenectomy for prostate cancer is an important tool in the prognostication of the disease in selected patients who are at risk of occult lymph node metastases. This procedure, usually performed in conjunction with radical prostatectomy, had progressed successfully from an open approach to the current robot-assisted approach. The following article and accompanying video describe the surgical technique of robot-assisted pelvic lymphadenectomy for prostate cancer. We also discuss the indications, patient selection, preparation, complications, and tips to avoid the major pitfalls in the procedure.

Le curage ganglionnaire dans le cancer de la prostate : une mise au point du comité de cancérologie de l’association française d’urologie

Lymph node invasion is the first step of metastatic evolution of prostate cancer. In this case, today, no local treatment should be proposed. Detection of lymph node invasion is performed by CT-scan and RMI, which show hypertrophied nodes. No difference in term of sensibility and specificity is observed between CT-scan and RMI. Invaded nodes are defined by modifications of size, form, and aspect of the architecture of nodes. Sentinel node belongs to expert centers. Surgical lymphadenectomy remains the best way to evaluate lymph node status. Limited to ilio-obturator land, it underestimates the risk of lymph node invasion: Extended lymph node excision defined by the association of bilateral ilio-obturator, internal iliaca and external iliaca lymphadenectomy should be systematically proposed to intermediate and high risk prostate cancer. A "well done" lymphadenectomy is represented by more than 10 nodes removed. Lymph node invasion represents bad prognosis. However, therapeutic value and influence of prognosis of lymphadenectomy in prostate cancer is still not established. Therefore, one or two invade lymph nodes represented a population of patients with better prognosis, specially if no capsular effraction is observed. After radical prostatectomy, in case of lymph node invasion, immediate hormonotherapy is the standard; however, this treatment is discussed in case of low number of invaded nodes (one or two) and if postoperative PSA is equal to zero. In this case, radiotherapy is still in evaluation and chemotherapy has no indication.

Standard Lymph Node Dissection for Bladder Cancer: Significant Variability in the Number of Reported Lymph Nodes

We compared the nodal yield after histopathological examination of extended bilateral pelvic lymph node dissection specimens for bladder cancer at 2 hospitals. Surgery at each hospital was done by the same 4 staff urologists using a standardized extended bilateral pelvic lymph node dissection template. All consecutive patients with bladder cancer who underwent extended bilateral pelvic lymph node dissection from January 1, 2007 to December 31, 2009 were included in this study. Specimens were sent for pathological evaluation in a minimum of 2 packages per side. At the 2 pathology departments specimens were processed according to institutional protocols. A total of 174 patients with a mean age of 62.7 years were included in analysis. At hospital 1 a mean of 16 lymph nodes were found after dissection vs a mean of 28 reported at hospital 2 (p <0.001). No significant differences were found in the number of tumor positive lymph nodes (p = 0.65). Mean lymph node density at hospitals 1 and 2 was 9.3% and 3.9%, respectively (p = 0.056). Despite equal anatomical clearance by the same experienced surgeons we report a statistically significant difference between 2 pathology departments where the number of lymph nodes was evaluated after extended bilateral pelvic lymph node dissection for bladder cancer. Unless standardized methods are agreed on by pathologists, the number of reported lymph nodes as an indicator of surgical quality and lymph node density as a prognostic factor should be used cautiously.

Quality and outcomes of robotic lymphadenectomy for prostate cancer in obese and morbidly obese patients

RESULTS: Mean BMI among the 819 patients was 30kg/m2 (1852kg/m) with 421 of BMI 30kg/m, 358 obese, and 40 morbidly bese and no difference among groups in proportion of high-risk atients. Mean total operative time was 148min, 157min, and 78min for normal, obese, and morbidly obese patients, respectively p 0.05). Estimated blood loss was 109mL, 128mL and 156mL p 0.05) with transfusion rate of only 0.4% and none in the moridly obese group. Mean hospitalization was 1.0d in all three groups. ean nodal yields were 9.6, 9.9, and 10.6 nodes for normal, obese nd morbidly obese patients (p NS). Extended PLND was perormed in 18%, 19%, and 15% with mean yields of 16.7, 15.3, and 16.5 odes, respectively (p NS). Node positivity was identified in 5.2%, .7%, and 12.5% (p NS). Complications of PLND occurred in 2%, %, and 5%, which were mostly symptomatic lymphoceles.

Biochemical Recurrence After Radical Prostatectomy: Multiplicative Interaction Between Surgical Margin Status and Pathological Stage

A positive surgical margin after radical prostatectomy is considered an adverse prognostic feature. However, few groups have explored the potential interaction between surgical margin status and other cancer characteristics, specifically pathological stage. We addressed the first degree of interaction between positive surgical margins and other established adverse predictors of biochemical recurrence after radical prostatectomy. We used univariate and multivariate analysis to test the effect of surgical margin status on biochemical recurrence in 4,490 patients treated at a single institution between 1992 and 2008. We systematically tested all first-degree interactions between surgical margin status, and pretreatment prostate specific antigen, pT and pN stage, and radical prostatectomy Gleason sum. If interactions were significant, we quantified the effect on the biochemical recurrence rate. Overall 850 patients (18.9%) had positive surgical margins. In those with negative vs positive surgical margins the 5-year biochemical recurrence-free survival rate was 95% vs 83%, 74% vs 62% and 47% vs 29% for pT2, pT3a and pT3b disease, respectively. In multivariate models only the pT stage-surgical margin status interaction achieved independent predictor status (p = 0.003). Negative vs positive surgical margin multivariate HRs were 1 vs 2.9, 2.3 vs 4.3 and 4.1 vs 5.6 in pT2, pT3a and pT3b cases, respectively. Compared to negative surgical margins, positive surgical margins increase the absolute biochemical recurrence 5-year rate by 12% to 18%. More importantly, positive surgical margins may substantially worsen the prognosis beyond that of the original pathological disease stage.

912 ROBOTIC LIMITED AND EXTENDED PELVIC LYMPHADENECTOMY FOR PROSTATE CANCER

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy II1 Apr 2010912 ROBOTIC LIMITED AND EXTENDED PELVIC LYMPHADENECTOMY FOR PROSTATE CANCER Hugh Lavery and Ronney Abaza Hugh LaveryHugh Lavery More articles by this author and Ronney AbazaRonney Abaza More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1668AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The optimal extent of lymphadenectomy for prostate cancer is unknown. More extensive dissections have shown increased overall nodal yields as well as more frequent identification of positive nodes. With the advent of robot-assisted laparoscopic prostatectomy (RALP), the ability to achieve adequate lymph node dissections with this approach has been questioned with many series reporting lower nodal yields than historical series or lower nodal positivity than expected based upon the biology of the disease. We reviewed our experience with both extended (ePLND) and limited pelvic lymphadenectomy (PLND) to determine nodal yield, complications, and rate of node positivity. METHODS We reviewed 250 consecutive RALP procedures with PLND from Feb 2008 to Jan 2009 by a single surgeon (RA). Nodal packets were dissected en bloc and nodes counted before paraffin-embedding to prevent double counting from cutting of nodes. Pathology processing was without knowledge of the study. ¡°Low-risk¡± patients underwent a limited PLND including the external iliac and obturator lymph nodes. An extended dissection was performed in ¡°high-risk¡± patients with preoperative PSA >10ng/dl, cT3 disease, Gleason ¡Ý8, or cancer in ¡Ý50% of biopsy tissue extending the template to all nodes medial to the genitofemoral nerve including the hypogastric nodes and common iliac nodes up to the crossing of the ureter. Patient and pathologic outcomes were evaluated. RESULTS Of 250 patients, 173 underwent limited PLND while 77 underwent ePLND. Mean nodal yield for all patients was 11 nodes, with 8.6 and 16.4 nodes for limited and extended PLND, respectively. A total of 17 (7%) node-positive (N+) patients were identified overall, with 2 (1.1%) in the limited group and 15 (19.5%) in the ePLND group. Of the 183 organ-confined (OC) tumors, only 1 was N+ (0.5%), compared to 16 of 67 (24%) non-OC tumors. Complications of the lymphadenectomy included four symptomatic lymphoceles requiring percutaneous drainage, one ureteral injury requiring a temporary stent, and one transient obturator nerve palsy for an overall complication rate of 2.4% (0.5% of limited and 8% of ePLND). CONCLUSIONS Pelvic lymphadenectomy for prostate cancer can be adequately performed in robot-assisted laparoscopic fashion with nodal yields and rate of positivity comparable to published open surgical series. The role of limited PLND remains unclear, but ePLND appears warranted for high risk cancers. Columbus, OH© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byAbaza R, Dangle P, Gong M, Bahnson R and Pohar K (2018) Quality of Lymphadenectomy is Equivalent With Robotic and Open Cystectomy Using an Extended TemplateJournal of Urology, VOL. 187, NO. 4, (1200-1205), Online publication date: 1-Apr-2012. Volume 183Issue 4SApril 2010Page: e356 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hugh Lavery More articles by this author Ronney Abaza More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Results of robotic limited and extended pelvic lymphadenectomy for prostate cancer

Results of robotic limited and extended pelvic lymphadenectomy for prostate cancer

Commentary on: Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2,000 patients

Lymph node metastases are one of the most important prognostic factors in prostate cancer. N staging directly influences the treatment decision in patients for whom potentially curative treatments are planned. However, the authors [1] provide a reminder that there is an ongoing debate about which patients require lymph node resection and how the dissection should be extended [2]. The Augsburg group first developed and described sentinel lymphadenectomy (SLNE) in prostate cancer. They have demonstrated through some studies that the majority of sentinel lymph node (SLN) and non-SLN metastases were found along the internal iliac vessels and that limited lymphadenectomy to obturator fossa was clearly insufficient for accurate lymph node staging. These findings are sustained by the majority of studies reporting on extended pelvic lymphadenectomy in prostate cancer. In this study, they reported the largest series with more than 2,000 patients who underwent SLNE alone or in combination with either standard or extended lymphadenectomy. It is the most important published manuscript in the literature. However, this study gathers heterogeneous subgroups of patients. The first goal of the study was to evaluate the

Lymph node assessment and lymphadenectomy in prostate cancer

The role of lymph node assessment for patients with clinically localized prostate cancer has significantly evolved over the last 20 years. The status of pelvic lymph nodes primarily served as a prognostic marker for prostate cancer. Improved methods in assessing the risk for cancer progression and metastasis have enhanced our ability to identify patients who require pelvic lymphadenectomy during radical prostatectomy. The status of pelvic lymph nodes is also being used to guide further treatments after surgery. Also, recent data has shown possible therapeutic benefit of lymphadenectomy in improving cancer specific survival.

Extended pelvic lymphadenectomy for prostate cancer: Will the previously reported benefits be reproduced in hospitals with lower surgical volumes?

Extended pelvic lymphadenectomy for prostate cancer: Will the previously reported benefits be reproduced in hospitals with lower surgical volumes?

Pelvic lymphadenectomy in prostate cancer

This review analyzes the anatomy of the prostate gland's lymphatic drainage, the optimal anatomic extend of pelvic lymph node dissection (PLND) and which dissection may be superior, who should undergo a PLND during prostatectomy, and its potential therapeutic benefits and complications. The prostate gland's lymphatic drainage can be variable, but frequently metastatic disease is found in the internal iliac chain. We conclude that the extended PLND yields the most lymph nodes and therefore may be superior. Some have demonstrated an unproven survival benefit after performing an extended PLND, possibly from removal of occult disease or from more accurate staging.

Radical Cystectomy for Carcinoma of the Bladder: 2,720 Consecutive Cases 5 Years Later

We performed a critical analysis of the results of radical cystectomy for invasive bladder carcinoma treated at 1 center. Between 1970 and 2000, 2,090 men and 630 women with invasive bladder cancer were treated with 1-stage radical cystectomy and urinary diversion. Followup ranged from 0 to 34.2 years with a mean of 5.5 +/- 5.7. Survival data were correlated to patient and tumor characteristics using univariate and multivariate analysis. Postoperative mortality was 2.6%. Squamous tumors accounted for 49.4% of cases, transitional cell carcinoma for 36.4% and adenocarcinoma for 9.6%. Regional lymph nodes were involved in 20.4% of cases. The 5 and 10-year disease-free survival rates were 55.5% and 50.03%, respectively. Evidence was provided that tumor stage, histological grade and lymph node status are the only independent variables which affect survival probability. Contemporary cystectomy can be performed with minimal mortality. Radical cystectomy for organ confined disease is followed by good therapeutic results and enhances the possibilities for functional restoration. With stage progression there is a stepwise reduction in survival probability. The radical operation can provide disease-free survival for an important subgroup of node positive cases (27.3%). Additional therapy is needed to improve the oncological outcome for advanced locoregional disease.

Extended lymph node dissection for prostate cancer

Lymph node status is an important determinant for the management of patients with newly diagnosed prostate cancer. Given the significant limitations of cross-sectional and functional preoperative imaging in the detection of small metastases, pelvic lymph node dissection remains the only reliable staging method in clinically localized prostate cancer. Although lymph node dissection is a well-established form of staging in prostate cancer, controversy remains about indications and the surgical extent of the procedure. Reported practices vary from omitting pelvic lymph node dissection in low-risk disease to routine pelvic lymph node dissection in all radical prostatectomy patients. This review highlights the recent literature concerning pelvic lymphadenectomy in prostate cancer with respect to anatomical extent and oncologic outcome.

VID-01.11: Technique of laparoscopic extended lymphadenectomy for prostate cancer

VID-01.11: Technique of laparoscopic extended lymphadenectomy for prostate cancer