Prostate CancerComplications and Other Surgical Outcomes Associated with Extended Pelvic Lymphadenectomy in Men with Localized Prostate Cancer
Introduction
Pelvic lymph node dissection (PLND), or pelvic lymphadenectomy, represents the most accurate staging procedure for presence of lymph node invasion (LNI) in clinically localized prostate cancer [1]. The prevalence of LNI ranges from 1.1% to 26% [2], [3], [4], [5], [6], [7], [8] and is related to PLND extent [2], [3], [4]. Indeed, extended PLNDs (ePLNDs) identify metastases that would not otherwise be detected by a limited PLND (lPLND) [9]. However, ePLND represents a technically more-challenging surgery and may be associated with higher rates of intraoperative and postoperative complications [10], [11]. These complications may in turn translate into a longer hospital stay. Higher complication rates and longer hospital stay may partially offset the staging and/or cancer control benefits of ePLND. We assessed the effect of PLND extent on these variables and performed multivariate analyses to control for patient age and cancer characteristics.
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Materials and methods
Between November 2002 and November 2005, 1033 patients were treated with radical retropubic prostatectomy (RRP) and PLND for localized prostate cancer at a single institution. Seventy (6.8%) patients were excluded because of missing data regarding the number of removed lymph nodes, which resulted in 963 evaluable patients who were treated by seven different surgeons. Of these, 767 (79.6%) underwent a PLND, in which ≥10 lymph nodes were removed and examined. These patients were referred to as
Results
Patient age ranged from 45 to 85 yr (mean age: 65.1). Clinical stages were T1c in 551 of 963 (57.2%), T2 in 374 of 963 (38.8%), T3 in 36 of 963 (3.7%), and missing in 2 (0.2%) patients. Biopsy Gleason sums were ≤6 in 599 (62.2%) patients, 7 in 240 (24.9%), 8–10 in 75 (7.8%), and missing in 49 (5.1%) (Table 1). PSA ranged from 0.02 to 240 ng/ml (mean: 10.8; median: 7.0). LNI was detected in 94 (9.8%) patients. The number of nodes removed ranged from 1 to 40 (mean: 15.5; median: 15). The mean
Discussion
Several studies suggest that more-extensive PLND might be associated with a higher rate of LNI [2], [3], [4], [5]. However, few studies [3], [5], [10], [11] systematically assessed the complications associated with contemporary PLNDs Even fewer studies [3], [5], [10] addressed the complication rates of ePLND. PLND complications range from 2% to 51% (Table 4) [2], [3], [4], [5], [10], [11], [16], [17], [18], [19], [20]. Discordant results were reported regarding the complication rates according
Conclusions
Extended PLND is associated with a threefold increase in the overall rate of complications relative to lPLND. Moreover, the rate of complications increases in a virtually direct proportion to the number of removed nodes. Finally, ePLND also translates into longer hospital stay. These detriments need to be taken into account when the staging benefit associated with ePLND is considered.
Acknowledgements
This study was partially supported by the Fonds de la Recherche en Santé du Québec, the CHUM Foundation, the Department of Surgery and Les Urologues Associés du CHUM (to P.I.K.).
Alberto Briganti and Felix K-H Chun contributed equally to the manuscript.
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