Detecting Lymph Nodes Metastasis in Prostate Cancer through Extended vs. Standard Laparoscopic Pelvic Lymphadenectomy

 

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Abstract

Introduction / Objective: Pelvic lymphadenecto­my is the best method for staging localized prostate cancer. There is no consensus about how the pelvic lymphadenectomy should be performed for patients with cT2, Gleason score 7 or higher, PSA higher than 10 ng / mL. Scintigraphic studies of prostate lymph drainage show that many lymph nodes are not dissected according to the current recommendation of lymphadenectomy which could explain the high rate of cancer recurrence. The objectives of this work are an analysis of the local lymph node metastasis according to the preoperative data (digital examination, PSA and Gleason score) and a comparison between ­laparoscopic extended and limited pelvic lymph­ad­enectomy, for staging, their technique and complications. Methods: Two groups were created for analysis. The indications for laparoscopic pelvic lymph­adenectomy are the following: preoperative PSA 10 ng / mL or higher, Gleason score 7 or higher and / or digital examination cT2. Patients with suspected distant metastasis were excluded. The first group is composed of the patients who under­went a limited laparoscopic pelvic lymph­adenectomy (LLPL) between January 1995 and December 2002. The medical data were analyzed retrospectively. The second group was created with patients who received extended laparoscopic pelvic lymphadenectomy (ELPL). These data were consecutively collected between November 2006 and October 2007. LLPL was the extraction of the external iliac and obturator lymph nodes. ELPL included, additionally, dissection of the internal iliac lymph nodes as well as tissue medial to the genitofemoral nerve. Histopatho­logical findings were compared with serum PSA, histopathological stage and preoperative biopsy. Complications, operating time, and number of ­extracted lymph nodes were also compared. Results: There were no significant differences in age, serum PSA or mean biopsy Gleason between two groups. The first group (LPLL) is composed of 381 patients and the second (ELPL), 163. The mean operating time was 72.5 minutes for LLPL and 84.3 for ELPL. The mean number of lymph nodes extracted was 13.8 (LLPL) and 31.1 (ELPL). Metastases were detected in 18.8 % (LLPL) and 24.7 % (ELPL). In 37.5 % of cases, the metastasis occurred in lymph nodes outside from those dissected by LPLL. The rates of complications and conversion rate were not significantly different for the two groups. Conclusions: For patients with clinically local­ized prostate cancer, ELPL is associated with a higher rate of detection of lymph node metastasis ­outside of the field dissected in the LPLL. Pelvic lymph­adenectomy, especially extraction of the lymph nodes of the internal iliac is important in patients with preoperative Gleason score 7 or greater and / or serum PSA greater than 10 ng / mL. Laparoscopic lymphadenectomy does not augment the rate of complications and is an excellent technique in prostate cancer staging. 

References

• 1 Golimbu M, Moralis P, Al-Askari S et al. Extended pelvic lymphadenectomy for prostatic cancer.  J Urol. 1979;  121 617-619
  PubMedGoogle Scholar
• 2 Gervasi L A, Mata J, Easley J D et al. Prognostic significance of lymph ­nodal metastases in prostate cancer.  J Urol. 1989;  142 (2 Pt 1) 332-336
  PubMedGoogle Scholar
• 3 Partin A W, Kattan M W, Subong E N et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update.  JAMA. 1997;  277 1445-1451
  CrossrefPubMedGoogle Scholar
• 4 Cheng L, Zincke H, Blute M L et al. Risk of prostate carcinoma death in patients with lymph node metastasis.  Cancer. 2001;  91 66-73
  CrossrefPubMedGoogle Scholar
• 5 Shackley D C, Irving S O, Brough W A et al. Staging laparoscopic pelvic lymphadenectomy in prostate cancer.  BJU Int. 1999;  83 260-264
  CrossrefPubMedGoogle Scholar
• 6 Heidenreich A, Zoltan V, von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis.  J Urol. 2002;  167 1681-1686
  CrossrefPubMedGoogle Scholar
• 7 Burkhard F C, Bader P, Schneider E et al. Reliability of preoperative values to determine the need for lymphadenectomy in patients with prostate cancer and meticulous lymph node dissection.  Eur Urol. 2002;  42 84-92
  CrossrefPubMedGoogle Scholar
• 8 Allaf M E, Palapattu G S, Trock B J et al. Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer.  J Urol. 2004;  172 (5 Pt 1) 1840-1844
  CrossrefPubMedGoogle Scholar
• 9 Touijer K, Rabbani F, Otero J R et al. Standard versus limited pelvic lymph node dissection for prostate cancer in patients with a predicted probability of nodal metastasis greater than 1 %.  J Urol. 2007;  178 120-124
  CrossrefPubMedGoogle Scholar
• 10 Mattei A, Fuechsel F G, Bhatta Dhar N et al. The template of the primary lymphatic landing sites of the prostate should be revisited: ­results of a multimodality mapping study.  Eur Urol. 2008;  53 118-125
  CrossrefPubMedGoogle Scholar
• 11 Meinhardt W. Sentinel node evaluation in prostate cancer.  EAU-EBU Update series. 2007;  5 223-231
  PubMedGoogle Scholar
• 12 Bader P, Burkhard F C, Markwalder R et al. Disease progression and survival of patients with positive lymph nodes after radical prostatec­tomy. Is there a chance of cure?.  J Urol. 2003;  169 849
  CrossrefPubMedGoogle Scholar
• 13 Daneshmand S, Quek M L, Stein J P et al. Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results.  J Urol. 2004;  172 (6 Pt 1) 2252-2255
  CrossrefPubMedGoogle Scholar
• 14 Joslyn S A, Konety B R. Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer.  Urology. 2006;  68 121-125
  PubMedGoogle Scholar
• 15 Arai Y, Kanamaru H, Yoshimura K et al. Incidence of lymph node metastasis and its impact on long-term prognosis in clinically localized prostate cancer.  Int J Urol. 1998;  5 459-465
  CrossrefPubMedGoogle Scholar
• 16 Wawroschek F, Vogt H, Weckermann D et al. The sentinel lymph node concept in prostate cancer-first results of gamma probe-guided sentinel lymph node identification.  Eur Urol. 1999;  36 595-600
  CrossrefPubMedGoogle Scholar
• 17 Schuessler W W, Vancaillie T G, Reich H et al. Transperitoneal endosurgical lymphadenectomy in patients with localized prostate cancer.  J Urol. 1991;  145 988-991
  PubMedGoogle Scholar
• 18 Caggianno I, Karakiewicz P, Eastham J A et al. A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer.  J Urol. 2003;  170 1798-1803
  CrossrefPubMedGoogle Scholar
• 19 Häcker A, Jeschke S, Leeb K et al. Detection of pelvic lymph node metastases in patients with clinically localized prostate cancer: comparison of [^18F] fluorocholine positron emission tomography-computerized ­tomography and laparoscopic radioisotope guided sentinel lymph node dissection.  J Urol. 2006;  176 2014-2018
  CrossrefPubMedGoogle Scholar
• 20 Edelstein R A, Zietman A L, de las Morenas A et al. Implications of prostate micrometastases in pelvic lymph nodes: an archival tissue study.  Urology. 1996;  47 370-375
  CrossrefPubMedGoogle Scholar

L. F. ArenasM. D. 

Evangelisches und Johanniter Klinikum Nordrhein · Urologische Klinik

Steinbrinkstr. 96

46145 Oberhausen

Phone: +49 / 2 08 / 6 97 43 01

Email: luisfernando.arenasdasilva@ejk.de