Standard Versus Limited Pelvic Lymph Node Dissection for Prostate Cancer in Patients With a Predicted Probability of Nodal Metastasis Greater Than 1%
- 11 May 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 178 (1), 120-124
- https://doi.org/10.1016/j.juro.2007.03.018
Abstract
We determined the yield of standard vs limited pelvic lymphadenectomy in patients with a predicted risk of lymph node metastasis greater than 1% according to the Partin tables predicted probability of pathological stage. We also determined the feasibility of laparoscopic standard pelvic lymph node dissection. Of 1,269 patients with clinically localized prostate cancer undergoing radical prostatectomy, 648 had a Partin’s table predicted probability of lymph node invasion greater than 1%. Of the 648 patients 177 underwent limited pelvic lymph node dissection performed laparoscopically (group 1), and 471 underwent standard pelvic lymph node dissection performed open (367) or laparoscopically (104) (group 2). Templates of limited pelvic lymph node dissection included the external iliac lymph nodes whereas standard pelvic lymph node dissection included the external iliac, obturator and hypogastric lymph nodes. Multivariate logistic regression analyses were performed to compare the node positivity rate between groups 1 and 2. On multivariate logistic regression analysis controlling for prostate specific antigen, biopsy Gleason sum, clinical stage and surgical approach, the odds of node positivity were 7.15-fold higher (95% CI 2.49–20.5, p <0.001) for standard vs limited pelvic lymph node dissection. The median (mean) number of nodes retrieved was 9 (10) and 14 (15) after limited and standard pelvic lymph node dissection, respectively (p <0.001). A similar impact was observed in patients treated laparoscopically with standard vs limited pelvic lymph node dissection (odds ratio 15.6, 95% CI 3.7–66.4, p <0.001). Standard lymph node dissection yields positive nodes more frequently and retrieves a higher total nodal count than the often performed pelvic lymph node dissection limited to the external iliac nodes. Standard pelvic lymph node dissection is feasible through a transperitoneal laparoscopic approach.This publication has 20 references indexed in Scilit:
- PROGNOSIS OF PATIENTS WITH LYMPH NODE POSITIVE PROSTATE CANCER FOLLOWING RADICAL PROSTATECTOMY: LONG-TERM RESULTSJournal of Urology, 2004
- ANATOMICAL EXTENT OF LYMPH NODE DISSECTION: IMPACT ON MEN WITH CLINICALLY LOCALIZED PROSTATE CANCERJournal of Urology, 2004
- Disease Progression and Survival of Patients With Positive Lymph Nodes After Radical Prostatectomy. Is there a Chance of Cure?Journal of Urology, 2003
- Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional updatePublished by American Medical Association (AMA) ,1997
- Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: development of a system of patient selectionUrology, 1995
- Eliminating the Need for Bilateral Pelvic Lymphadenectomy in Select Patients with Prostate CancerJournal of Urology, 1994
- Lower Incidence of Unsuspected Lymph Node Metastases in 521 Consecutive Patients with Clinically Localized Prostate CancerJournal of Urology, 1992
- Extended experience with surgical treatment of stage D1 adenocarcinoma of prostate: Significant influences of immediate adjuvant hormonal treatment (orchiectomy) on outcomeUrology, 1989
- Prostatic Carcinoma: Incidence and Location of Unsuspected Lymphatic MetastasesJournal of Urology, 1976
- Carcinoma of the Prostate and Lymphatic MetastasesJournal of Urology, 1974