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09.02.2018 | Original Article

Multicenter evaluation of guideline adherence for pelvic lymph node dissection in patients undergoing open retropubic vs. laparoscopic or robot assisted radical prostatectomy according to the recent German S3 guideline on prostate cancer

verfasst von: Angelika Borkowetz, Johannes Bruendl, Martin Drerup, Jonas Herrmann, Hendrik Isbarn, Burkhard Beyer, On behalf of the GeSRU Academics Prostate Cancer Group

Erschienen in: World Journal of Urology | Ausgabe 6/2018

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Abstract

Purpose

Pelvic lymph node dissection (PLND) is recommended for patients with prostate cancer (PCa) and significant risk for nodal metastases. This study aimed to assess guideline adherence regarding PLND according to the German S3 guideline as example for a national but highly used guideline on prostate cancer and to compare the rate of complications different approaches for radical prostatectomy (RP).

Methods

Patients undergoing open (RRP), laparoscopic (LARP) or robot-assisted (RARP) RP in six centers in Germany and Austria were included. The primary endpoint was the total number of removed lymph nodes (LN) between the different surgical approaches according to recent guideline recommendations. Secondary endpoints were the number of patients undergoing a sufficient PLND, defined as a removal of at least 10 LN and associated complication rates.

Results

2634 patients undergoing RP were included (RRP: 66%, RARP/LARP: 34%). PLND was performed in 88% (RRP: 88.5%, RARP/LARP: 86.8%, p = 0.208). In intermediateor high risk PCa, PLND was performed in 97.2% (RRP: 97.7%, RARP/LARP: 96.2, p = 0.048). Of those, the mean number of LN was 19 (RRP: 19 vs. RARP/LARP: 17, p < 0.005) and sufficient PLND was observed in 84.6% of RRP compared to 77.2% of RARP/LARP (p < 0.005). Symptomatic lymphoceles requiring surgical treatment occurred more often in RRP than in RARP/LARP (4.0% vs. 1.6%, p = 0.001).

Conclusions

The general guideline adherence regarding performing PNLD and the LN yield is high, regardless of the surgical approach. As expected, lymph node yield was higher when very experienced surgeons conducted the procedure. This should be considered in patients’ counseling.

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 CrossRefPubMed

Mohler JL, Armstrong AJ, Bahnson RR, D’Amico AV, Davis BJ, Eastham JA, Enke CA, Farrington TA, Higano CS, Horwitz EM, Hurwitz M, Kane CJ, Kawachi MH, Kuettel M, Lee RJ, Meeks JJ, Penson DF, Plimack ER, Pow-Sang JM, Raben D, Richey S, Roach M 3rd, Rosenfeld S, Schaeffer E, Skolarus TA, Small EJ, Sonpavde G, Srinivas S, Strope SA, Tward J, Shead DA, Freedman-Cass DA (2016) Prostate cancer, version 1.2016. J Natl Compr Cancer Netw 14(1):19–30CrossRef

Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, Fossati N, Gross T, Henry AM, Joniau S, Lam TB, Mason MD, Matveev VB, Moldovan PC, van den Bergh RCN, Van den Broeck T, van der Poel HG, van der Kwast TH, Rouviere O, Schoots IG, Wiegel T, Cornford P (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71(4):618–629. https://doi.org/10.1016/j.eururo.2016.08.003 CrossRefPubMed

Grimm MO, Thomas C, Frohner M, Wiegel T, Heidenreich A, Thuroff JW, Wirth M (2010) Pelvic lymphadenectomy and radical prostatectomy. Recommendations of the German S3 guideline. Urol A 49(2):206–210. https://doi.org/10.1007/s00120-010-2237-4 CrossRef

Bader P, Burkhard FC, Markwalder R, Studer UE (2003) Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol 169(3):849–854. https://doi.org/10.1097/01.ju.0000049032.38743.c7 CrossRefPubMed

Binder J, Kramer W (2001) Robotically-assisted laparoscopic radical prostatectomy. BJU Int 87(4):408–410CrossRefPubMed

Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR (1997) Laparoscopic radical prostatectomy: initial short-term experience. Urology 50(6):854–857. https://doi.org/10.1016/S0090-4295(97)00543-8 CrossRefPubMed

Cooperberg MR, Kane CJ, Cowan JE, Carroll PR (2010) Adequacy of lymphadenectomy among men undergoing robot-assisted laparoscopic radical prostatectomy. BJU Int 105(1):88–92. https://doi.org/10.1111/j.1464-410X.2009.08699.x CrossRefPubMed

Silberstein JL, Vickers AJ, Power NE, Parra RO, Coleman JA, Pinochet R, Touijer KA, Scardino PT, Eastham JA, Laudone VP (2012) Pelvic lymph node dissection for patients with elevated risk of lymph node invasion during radical prostatectomy: comparison of open, laparoscopic and robot-assisted procedures. J Endourol 26(6):748–753. https://doi.org/10.1089/end.2011.0266 CrossRefPubMedPubMedCentral

10.

Ploussard G, Briganti A, de la Taille A, Haese A, Heidenreich A, Menon M, Sulser T, Tewari AK, Eastham JA (2014) Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature. Eur Urol 65(1):7–16. https://doi.org/10.1016/j.eururo.2013.03.057 CrossRefPubMed

11.

Yuh BE, Ruel NH, Mejia R, Novara G, Wilson TG (2013) Standardized comparison of robot-assisted limited and extended pelvic lymphadenectomy for prostate cancer. BJU Int 112(1):81–88. https://doi.org/10.1111/j.1464-410X.2012.11788.x CrossRefPubMed

12.

Albisinni S, Aoun F, Le Dinh D, Zanaty M, Hawaux E, Peltier A, Vanv A (2017) Comparing conventional laparoscopic to robotic-assisted extended pelvic lymph node dissection in men with intermediate and high-risk prostate cancer: a matched-pair analysis. Minerva Urol Nefrol 69(1):101–107. https://doi.org/10.23736/S0393-2249.16.02799-5 PubMedCrossRef

13.

Frota R, Turna B, Barros R, Gill IS (2008) Comparison of radical prostatectomy techniques: open, laparoscopic and robotic assisted. Int Braz J Urol 34(3):259–268 (discussion 268–259) CrossRefPubMed

14.

Briganti A, Chun FK, Salonia A, Suardi N, Gallina A, Da Pozzo LF, Roscigno M, Zanni G, Valiquette L, Rigatti P, Montorsi F, Karakiewicz PI (2006) Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol 50(5):1006–1013. https://doi.org/10.1016/j.eururo.2006.08.015 CrossRefPubMed

15.

Eifler JB, Cookson MS (2014) Best evidence regarding the superiority or inferiority of robot-assisted radical prostatectomy. Urol Clin North Am 41(4):493–502. https://doi.org/10.1016/j.ucl.2014.07.004 CrossRefPubMed

16.

Joslyn SA, Konety BR (2006) Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology 68(1):121–125. https://doi.org/10.1016/j.urology.2006.01.055 CrossRefPubMed

17.

Budiharto T, Joniau S, Lerut E, Van den Bergh L, Mottaghy F, Deroose CM, Oyen R, Ameye F, Bogaerts K, Haustermans K, Van Poppel H (2011) Prospective evaluation of 11C-choline positron emission tomography/computed tomography and diffusion-weighted magnetic resonance imaging for the nodal staging of prostate cancer with a high risk of lymph node metastases. Eur Urol 60(1):125–130. https://doi.org/10.1016/j.eururo.2011.01.015 CrossRefPubMed

18.

Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, Henry AM, Joniau S, Lam TB, Mason MD, van der Poel HG, van der Kwast TH, Rouviere O, Wiegel T, Mottet N (2017) EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur Urol 71(4):630–642. https://doi.org/10.1016/j.eururo.2016.08.002 CrossRefPubMed

19.

Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS, D’Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen CM, Panel AUAPCCGU (2007) Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 177(6):2106–2131. https://doi.org/10.1016/j.juro.2007.03.003 CrossRefPubMed

20.

Suardi N, Larcher A, Haese A, Ficarra V, Govorov A, Buffi NM, Walz J, Rocco B, Borghesi M, Steuber T, Pini G, Briganti A, Mottrie AM, Guazzoni G, Montorsi F, Pushkar D, Van Der Poel H, Section EAUYAU-R (2014) Indication for and extension of pelvic lymph node dissection during robot-assisted radical prostatectomy: an analysis of five European institutions. Eur Urol 66(4):635–643. https://doi.org/10.1016/j.eururo.2013.12.059 CrossRefPubMed

21.

Schiffmann J, Larcher A, Sun M, Tian Z, Berdugo J, Leva I, Widmer H, Lattouf JB, Zorn KC, Shariat SF, Montorsi F, Graefen M, Saad F, Karakiewicz PI (2016) Suboptimal use of pelvic lymph node dissection: differences in guideline adherence between robot-assisted and open radical prostatectomy. Can Urol Assoc J 10(7–8):269–276. https://doi.org/10.5489/cuaj.3563 CrossRefPubMedPubMedCentral

22.

Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI (2012) Lymph node count threshold for optimal pelvic lymph node staging in prostate cancer. Int J Urol 19(7):645–651. https://doi.org/10.1111/j.1442-2042.2012.02993.x CrossRefPubMed

23.

Abdollah F, Sun M, Briganti A, Thuret R, Schmitges J, Gallina A, Suardi N, Capitanio U, Salonia A, Shariat SF, Perrotte P, Rigatti P, Montorsi F, Karakiewicz PI (2011) Critical assessment of the European Association of Urology guideline indications for pelvic lymph node dissection at radical prostatectomy. BJU Int 108(11):1769–1775. https://doi.org/10.1111/j.1464-410X.2011.10204.x CrossRefPubMed

24.

Choo MS, Kim M, Ku JH, Kwak C, Kim HH, Jeong CW (2017) Extended versus standard pelvic lymph node dissection in radical prostatectomy on oncological and functional outcomes: a systematic review and meta-analysis. Ann Surg Oncol 24(7):2047–2054. https://doi.org/10.1245/s10434-017-5822-6 CrossRefPubMed

25.

Schiavina R, Manferrari F, Garofalo M, Bertaccini A, Vagnoni V, Guidi M, Borghesi M, Baccos A, Morselli-Labate AM, Concetti S, Martorana G (2011) The extent of pelvic lymph node dissection correlates with the biochemical recurrence rate in patients with intermediate- and high-risk prostate cancer. BJU Int 108(8):1262–1268. https://doi.org/10.1111/j.1464-410X.2010.10016.x CrossRefPubMed

26.

Allaf ME, Palapattu GS, Trock BJ, Carter HB, Walsh PC (2004) Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol 172(5 Pt 1):1840–1844CrossRefPubMed

27.

DiMarco DS, Zincke H, Sebo TJ, Slezak J, Bergstralh EJ, Blute ML (2005) The extent of lymphadenectomy for pTXNO prostate cancer does not affect prostate cancer outcome in the prostate specific antigen era. J Urol 173(4):1121–1125. https://doi.org/10.1097/01.ju.0000155533.93528.4c CrossRefPubMed

28.

Mitropoulos D, Artibani W, Graefen M, Remzi M, Roupret M, Truss M, European Association of Urology Guidelines P (2012) Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 61(2):341–349. https://doi.org/10.1016/j.eururo.2011.10.033 CrossRefPubMed

29.

Froehner M, Novotny V, Koch R, Leike S, Twelker L, Wirth MP (2013) Perioperative complications after radical prostatectomy: open versus robot-assisted laparoscopic approach. Urol Int 90(3):312–315. https://doi.org/10.1159/000345323 CrossRefPubMed

30.

Groeben C, Koch R, Baunacke M, Wirth MP, Huber J (2016) Robots drive the German radical prostatectomy market: a total population analysis from 2006 to 2013. Prostate Cancer Prostatic Dis 19(4):412–416. https://doi.org/10.1038/pcan.2016.34 CrossRefPubMed

Titel: Multicenter evaluation of guideline adherence for pelvic lymph node dissection in patients undergoing open retropubic vs. laparoscopic or robot assisted radical prostatectomy according to the recent German S3 guideline on prostate cancer
verfasst von: Angelika Borkowetz
Johannes Bruendl
Martin Drerup
Jonas Herrmann
Hendrik Isbarn
Burkhard Beyer
On behalf of the GeSRU Academics Prostate Cancer Group
Publikationsdatum: 09.02.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 6/2018
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2195-9

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Multicenter evaluation of guideline adherence for pelvic lymph node dissection in patients undergoing open retropubic vs. laparoscopic or robot assisted radical prostatectomy according to the recent German S3 guideline on prostate cancer

Abstract

Purpose

Methods

Results

Conclusions

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