You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2014MP42-20 MAPPING OF PELVIC LYMPH NODES AFTER RADICAL PROSTATECTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION INCLUDING PRE-SACRAL AND COMMON ILIAC REGIONS Pieter Janssen, Lorenzo Tosco, Piet Dirix, Karin Haustermans, Sofie Isebaert, Hendrik Van Poppel, and Steven Joniau Pieter JanssenPieter Janssen More articles by this author , Lorenzo ToscoLorenzo Tosco More articles by this author , Piet DirixPiet Dirix More articles by this author , Karin HaustermansKarin Haustermans More articles by this author , Sofie IsebaertSofie Isebaert More articles by this author , Hendrik Van PoppelHendrik Van Poppel More articles by this author , and Steven JoniauSteven Joniau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1197AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives international guidelines recommend to perform extended pelvic lymph node dissection (ePLND) for intermediate (IRPCa) and high-risk prostate cancer (HRPCa) particularly in cases with a high probability of lymph node invasion (LNI). Recently the evidence of possible LNI in the pre-sacral area enhanced the role of ePLND and questions the role of different templates. Objective: to evaluate the presence of LNI and completeness of infiltrated node (N+) resection in ePLND templates including pre-sacral and common iliac regions. Methods 130 patients with I-HRPCa underwent radical prostatectomy (RP) and ePLND in one single university hospital between January 2006 and October 2013. The surgical template included standard regions with borders as defined in EAU guidelines plus two additional regions: 1) Common iliac region: aortic bifurcation, bifurcation of internal/external iliac arteries, psoas muscle and genito-femoral nerve and medial border of the common iliac artery 2) Pre-sacral region: triangle between medial borders of common iliac arteries and line connecting internal/external arteries’ bifurcations; dorsal border: promontory and proximal sacrum (S1–S2). After eliminating patients with merged fibro-fatty tissue from adjacent anatomic zones and patients with a risk of LNI <10%, 115 patients remained for analysis. Specimens were evaluated by one single dedicated pathologist. Results 3127 nodes were removed with 114 N+ (3.6%) in 48 patients (42%) of whom 2 with isolated tumor cells that were excluded from node count. Number of infiltrated lymph nodes and density of positive nodes (N+/Ntotal) per anatomical region were, respectively: common iliac 4 (0.91%), external iliac 31 (4.10%), internal iliac 44 (7.26%), obturator fossa 24 (2.52%) and pre-sacral area 11 (3.13%). 46 out of 115 patients (40%) had confirmed N+, and the standard ePLND template detected N+ in 43 (37%) patients. However, 11 patients (10%) had confirmed N+ in the pre-sacral and/or the common iliac regions, and thus would be under-staged through common ePLND templates. Furthermore, standard ePLND would have removed all N+ in only 35 patients (76% of all N+ patients), leaving 11 patients (24% of all N+ patients) with undetected and untreated N+. Conclusions Patients treated by RP + ePLND could be under-staged and undertreated in a non-negligible percentage of cases with N+. The introduction of pre-sacral and common iliac areas could correctly stage and treat all patients with high risk of LNI. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e476 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Pieter Janssen More articles by this author Lorenzo Tosco More articles by this author Piet Dirix More articles by this author Karin Haustermans More articles by this author Sofie Isebaert More articles by this author Hendrik Van Poppel More articles by this author Steven Joniau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...