Faculty Collaboration Database

Can pelvic node dissection at radical prostatectomy influence the nodal recurrence at salvage lymphadenectomy for prostate cancer? Investig Clin Urol 2018 Mar;59(2):83-90

Date

03/10/2018

Pubmed ID

29520383

Pubmed Central ID

PMC5840122

DOI

10.4111/icu.2018.59.2.83

Scopus ID

2-s2.0-85042880323 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

PURPOSE: To verify the quality of pelvic lymph node dissection (PLND) performed at radical prostatectomy (RP) and its impact on nodal recurrence in patients undergoing salvage lymph node dissection (sLND).

MATERIALS AND METHODS: Retrospective review of 48 patients who underwent sLND for presumed nodal recurrence, to describe the PLND characteristics at RP and correlate the anatomical sites and number of suspicious nodes reported in radiological imaging and final pathology of sLND.

RESULTS: Overall, at RP, 8 (16.7%) did not undergo PLND, 32 (66.7%) and 8 (16.7%) received a "limited" (between external iliac vein and obturator nerve) and an "extended" (external iliac, hypogastric, and obturator) dissection, respectively. Median nodes removed during limited and extended dissection were 2 and 24, respectively. At sLND, the mean age was 61.3 years and median prostate specific antigen (PSA) was 1.07 ng/mL. Median nodes removed at sLND were 17 with a median of 2 positive nodes. Recurrent nodes were identified within the template of an extended PLND in 62.5%, 50.0% and 12.5% patients, respectively, following prior no, limited and extended dissection at RP. Recurrence outside the expected lymphatic drainage pathway was noted in 37.5% patients with prior extended dissection at RP. There was a correlation between imaging and pathology specimen in 83% for node location and 58.3% for number of anatomical sites involved.

CONCLUSIONS: In prostate cancer patients undergoing sLND, most had inadequate PLND at the original RP. Pattern of nodal recurrence may be influenced by the prior dissection and pre sLND imaging appears to underestimate the nodal recurrence.

Author List

Sivaraman A, Benfante N, Touijer K, Coleman J, Scardino P, Laudone V, Eastham J

Author

Arjun Sivaraman MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Humans
Lymph Node Excision
Lymph Nodes
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Pelvis
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Retrospective Studies
Salvage Therapy
United States