Pelvic Lymph Node Dissection in Prostate Cancer

Alberto Briganti, Michael L. Blute, James H. Eastham, Markus Graefen, Axel Heidenreich, Jeffrey R. Karnes, Francesco Montorsi, Urs E. Studer

Research output: Contribution to journalArticle

Abstract

Context: Pelvic lymph node dissection (PLND) is considered the most reliable procedure for the detection of lymph node metastases in prostate cancer (PCa); however, the therapeutic benefit of PLND in PCa management is currently under debate. Objective: To systematically review the available literature concerning the role of PLND and its extent in PCa staging and outcome. All of the existing recommendations and staging tools determining the need for PLND were also assessed. Moreover, a systematic review was performed of the long-term outcome of node-positive patients stratified according to the extent of nodal invasion. Evidence acquisition: A Medline search was conducted to identify original and review articles as well as editorials addressing the significance of PLND in PCa. Keywords included prostate cancer, pelvic lymph node dissection, radical prostatectomy, imaging, and complications. Data from the selected studies focussing on the role of PLND in PCa staging and outcome were reviewed and discussed by all of the contributing authors. Evidence synthesis: Despite recent advances in imaging techniques, PLND remains the most accurate staging procedure for the detection of lymph node invasion (LNI) in PCa. The rate of LNI increases with the extent of PLND. Extended PLND (ePLND; ie, removal of obturator, external iliac, hypogastric with or without presacral and common iliac nodes) significantly improves the detection of lymph node metastases compared with limited PLND (lPLND; ie, removal of obturator with or without external iliac nodes), which is associated with poor staging accuracy. Because not all patients with PCa are at the same risk of harbouring nodal metastases, several nomograms and tables have been developed and validated to identify candidates for PLND. These tools, however, are based mostly on findings derived from lPLND dissections performed in older patient series. According to these prediction models, a staging PLND might be omitted in low-risk PCa patients because of the low rate of lymph node metastases found, even after extended dissections (

Original languageEnglish
Pages (from-to)1251-1265
Number of pages15
JournalEuropean Urology
Volume55
Issue number6
DOIs
Publication statusPublished - Jun 2009

Keywords

  • Complications
  • Imaging
  • Pelvic lymph node dissection
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

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  • Cite this

    Briganti, A., Blute, M. L., Eastham, J. H., Graefen, M., Heidenreich, A., Karnes, J. R., Montorsi, F., & Studer, U. E. (2009). Pelvic Lymph Node Dissection in Prostate Cancer. European Urology, 55(6), 1251-1265. https://doi.org/10.1016/j.eururo.2009.03.012