nach oben

Erschienen in:

16.05.2018 | Original Article

Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial

verfasst von: Nina Natascha Harke, Michael Godes, Christian Wagner, Mustapha Addali, Bernhard Fangmeyer, Katarina Urbanova, Boris Hadaschik, Jorn H. Witt

Erschienen in: World Journal of Urology | Ausgabe 11/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To demonstrate the benefits of fluorescence-supported extended pelvic lymph node dissection (ePLND) compared to regular ePLND in robot-assisted radical prostatectomy.

Methods

120 patients with intermediate- or high-risk prostate cancer were prospectively randomized (1:1): in the intervention group, indocyanine green (ICG) was injected transrectally into the prostate before docking of the robot. In both groups, ePLND was performed including additional dissection of fluorescent lymph nodes (LN) in the ICG group.

Results

After drop-out of two patients, 59 patients were allocated to the control (A) and intervention group (B) with a median PSA of 8,6 ng/ml. Median console time was 159 (A) vs. 168 (B) min (p = 0.20) with a longer time for ICG-ePLND: 43 (A) vs. 55 min (B) (p = 0.001). 2609 LN were found with significantly more LN after ICG-supported ePLND with a median of 25 vs. 17 LN in A (p < 0.001). Nodal metastases were detected in 6 patients in A (25 cancerous LN) vs. 9 patients in B (62 positive LN) (p = 0.40). In seven of nine patients, ICG-ePLND identified at least one cancer-positive LN (sensitivity 78%), 27 of 62 cancerous LN were fluorescent. Symptomatic lymphocele occurred in one patient in a and in three patients in b (p = 0.62). After a median follow-up of 22.9 months, PSA levels were similar.

Conclusions

While ICG-ePLND seems to be beneficial for a better understanding of the lymphatic drainage and a more meticulous diagnostic approach, the sensitivity is not sufficient to recommend stand-alone ICG lymph node dissection.

Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64(1):9–29. https://doi.org/10.3322/caac.21208 CrossRefPubMed

D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974CrossRef

Engel J, Bastian PJ, Baur H, Beer V, Chaussy C, Gschwend JE, Oberneder R, Rothenberger KH, Stief CG, Holzel D (2010) Survival benefit of radical prostatectomy in lymph node-positive patients with prostate cancer. Eur Urol 57(5):754–761. https://doi.org/10.1016/j.eururo.2009.12.034 CrossRef

Heidenreich A, Pfister D, Porres D (2015) Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases: results of a feasibility and case-control study. J Urol 193(3):832–838. https://doi.org/10.1016/j.juro.2014.09.089 CrossRefPubMed

Briganti A, Chun FK, Salonia A, Zanni G, Scattoni V, Valiquette L, Rigatti P, Montorsi F, Karakiewicz PI (2006) Validation of a nomogram predicting the probability of lymph node invasion among patients undergoing radical prostatectomy and an extended pelvic lymphadenectomy. Eur Urol 49(6):1019–1026. https://doi.org/10.1016/j.eururo.2006.01.043 Discussion 1026–1017 CrossRef

Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, Bianchi M, Sun M, Freschi M, Salonia A, Karakiewicz PI, Rigatti P, Montorsi F (2012) Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 61(3):480–487. https://doi.org/10.1016/j.eururo.2011.10.044 CrossRef

Shariat SF, Karakiewicz PI, Suardi N, Kattan MW (2008) Comparison of nomograms with other methods for predicting outcomes in prostate cancer: a critical analysis of the literature. Clin Cancer Res 14(14):4400–4407. https://doi.org/10.1158/1078-0432.CCR-07-4713 CrossRefPubMed

Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G, Wester HJ, Heck M, Kubler H, Beer AJ, Schwaiger M, Eiber M (2016) Diagnostic efficacy of (68)gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol 195(5):1436–1443. https://doi.org/10.1016/j.juro.2015.12.025 CrossRef

Mattei A, Fuechsel FG, Bhatta Dhar N, Warncke SH, Thalmann GN, Krause T, Studer UE (2008) The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol 53(1):118–125. https://doi.org/10.1016/j.eururo.2007.07.035 CrossRef

10.

Harbin AC, Eun DD (2015) The role of extended pelvic lymphadenectomy with radical prostatectomy for high-risk prostate cancer. Urol Oncol 33(5):208–216. https://doi.org/10.1016/j.urolonc.2014.11.011 CrossRefPubMed

11.

Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39(2):456–466CrossRef

12.

Wawroschek F, Vogt H, Weckermann D, Wagner T, Harzmann R (1999) The sentinel lymph node concept in prostate cancer—first results of gamma probe-guided sentinel lymph node identification. Eur Urol 36(6):595–600. https://doi.org/10.1159/000020054 CrossRefPubMed

13.

Jeschke S, Beri A, Grull M, Ziegerhofer J, Prammer P, Leeb K, Sega W, Janetschek G (2008) Laparoscopic radioisotope-guided sentinel lymph node dissection in staging of prostate cancer. Eur Urol 53(1):126–132. https://doi.org/10.1016/j.eururo.2007.03.064 CrossRefPubMed

14.

van der Poel HG, Buckle T, Brouwer OR, Valdes Olmos RA, van Leeuwen FW (2011) Intraoperative laparoscopic fluorescence guidance to the sentinel lymph node in prostate cancer patients: clinical proof of concept of an integrated functional imaging approach using a multimodal tracer. Eur Urol 60(4):826–833. https://doi.org/10.1016/j.eururo.2011.03.024 CrossRefPubMed

15.

Manny TB, Patel M, Hemal AK (2014) Fluorescence-enhanced robotic radical prostatectomy using real-time lymphangiography and tissue marking with percutaneous injection of unconjugated indocyanine green: the initial clinical experience in 50 patients. Eur Urol 65(6):1162–1168. https://doi.org/10.1016/j.eururo.2013.11.017 CrossRefPubMed

16.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRef

17.

Wit EMK, Acar C, Grivas N, Yuan C, Horenblas S, Liedberg F, Valdes Olmos RA, van Leeuwen FWB, van den Berg NS, Winter A, Wawroschek F, Hruby S, Janetschek G, Vidal-Sicart S, MacLennan S, Lam TB, van der Poel HG (2017) Sentinel node procedure in prostate cancer: a systematic review to assess diagnostic accuracy. Eur Urol 71(4):596–605. https://doi.org/10.1016/j.eururo.2016.09.007 CrossRefPubMed

18.

Hruby S, Englberger C, Lusuardi L, Schatz T, Kunit T, Abdel-Aal AM, Hager M, Janetschek G (2015) Fluorescence guided targeted pelvic lymph node dissection for intermediate and high risk prostate cancer. J Urol 194(2):357–363. https://doi.org/10.1016/j.juro.2015.03.127 CrossRef

19.

Nguyen DP, Huber PM, Metzger TA, Genitsch V, Schudel HH, Thalmann GN (2016) A specific mapping study using fluorescence sentinel lymph node detection in patients with intermediate- and high-risk prostate cancer undergoing extended pelvic lymph node dissection. Eur Urol 70(5):734–737. https://doi.org/10.1016/j.eururo.2016.01.034 CrossRefPubMed

20.

KleinJan GH, van den Berg NS, Brouwer OR, de Jong J, Acar C, Wit EM, Vegt E, van der Noort V, Valdes Olmos RA, van Leeuwen FW, van der Poel HG (2014) Optimisation of fluorescence guidance during robot-assisted laparoscopic sentinel node biopsy for prostate cancer. Eur Urol 66(6):991–998. https://doi.org/10.1016/j.eururo.2014.07.014 CrossRefPubMed

21.

KleinJan GH, van den Berg NS, de Jong J, Wit EM, Thygessen H, Vegt E, van der Poel HG, van Leeuwen FW (2016) Multimodal hybrid imaging agents for sentinel node mapping as a means to (re)connect nuclear medicine to advances made in robot-assisted surgery. Eur J Nucl Med Mol Imaging 43(7):1278–1287. https://doi.org/10.1007/s00259-015-3292-2 CrossRefPubMedPubMedCentral

22.

Ramirez-Backhaus M, Mira Moreno A, Gomez Ferrer A, Calatrava Fons A, Casanova J, Solsona Narbon E, Ortiz Rodriguez IM, Rubio Briones J (2016) Indocyanine green guided pelvic lymph node dissection: an efficient technique to classify the lymph node status of patients with prostate cancer who underwent radical prostatectomy. J Urol 196(5):1429–1435. https://doi.org/10.1016/j.juro.2016.05.087 CrossRefPubMed

23.

Yuen K, Miura T, Sakai I, Kiyosue A, Yamashita M (2015) Intraoperative fluorescence imaging for detection of sentinel lymph nodes and lymphatic vessels during open prostatectomy using indocyanine green. J Urol 194(2):371–377. https://doi.org/10.1016/j.juro.2015.01.008 CrossRefPubMed

24.

Weckermann D, Dorn R, Holl G, Wagner T, Harzmann R (2007) Limitations of radioguided surgery in high-risk prostate cancer. Eur Urol 51(6):1549–1556. https://doi.org/10.1016/j.eururo.2006.08.049 Discussion 1556–1548 CrossRefPubMed

25.

Joniau S, Van den Bergh L, Lerut E, Deroose CM, Haustermans K, Oyen R, Budiharto T, Ameye F, Bogaerts K, Van Poppel H (2013) Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol 63(3):450–458. https://doi.org/10.1016/j.eururo.2012.06.057 CrossRef

26.

Abdollah F, Gandaglia G, Suardi N, Capitanio U, Salonia A, Nini A, Moschini M, Sun M, Karakiewicz PI, Shariat SF, Montorsi F, Briganti A (2015) More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol 67(2):212–219. https://doi.org/10.1016/j.eururo.2014.05.011 CrossRef

27.

Schiavina R, Bianchi L, Borghesi M, Briganti A, Brunocilla E, Carini M, Terrone C, Mottrie A, Dente D, Gacci M, Gontero P, Gurioli A, Imbimbo C, La Manna G, Marchioro G, Milanese G, Mirone V, Montorsi F, Morgia G, Munegato S, Novara G, Panarello D, Porreca A, Russo GI, Serni S, Simonato A, Urzi D, Verze P, Volpe A, Martorana G (2016) Predicting survival in node-positive prostate cancer after open, laparoscopic or robotic radical prostatectomy: a competing risk analysis of a multi-institutional database. Int J Urol 23(12):1000–1008. https://doi.org/10.1111/iju.13203 CrossRefPubMed

28.

Grivas N, Wit E, Kuusk T, KleinJan G, Donswijk M, van Leeuwen F, van der Poel H (2017) The impact of adding sentinel node biopsy to extended pelvic lymph node dissection on the biochemical recurrence of prostate cancer patients treated with robot-assisted radical prostatectomy. J Nucl Med. https://doi.org/10.2967/jnumed.117.195644 CrossRefPubMed

Titel: Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial
verfasst von: Nina Natascha Harke
Michael Godes
Christian Wagner
Mustapha Addali
Bernhard Fangmeyer
Katarina Urbanova
Boris Hadaschik
Jorn H. Witt
Publikationsdatum: 16.05.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 11/2018
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2330-7

Neu im Fachgebiet Urologie

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Internistische Arzneimitteltherapie Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

ADT zur Radiatio nach Prostatektomie: Wenn, dann wohl länger

24.05.2024 Prostatakarzinom Nachrichten

Welchen Nutzen es trägt, wenn die Strahlentherapie nach radikaler Prostatektomie um eine Androgendeprivation ergänzt wird, hat die RADICALS-HD-Studie untersucht. Nun liegen die Ergebnisse vor. Sie sprechen für länger dauernden Hormonentzug.

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial