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INVITED COMMENTARY
Year : 2015  |  Volume : 17  |  Issue : 2  |  Page : 335

Extended lymph node dissection for intermediate and high-risk prostate cancer: do we have all the evidence?


Department of Urology, University of Rochester Medical Center, Rochester, NY, USA

Date of Web Publication02-Dec-2014

Correspondence Address:
Ahmed Ghazi
Department of Urology, University of Rochester Medical Center, Rochester, NY
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1008-682X.143042

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How to cite this article:
Ghazi A. Extended lymph node dissection for intermediate and high-risk prostate cancer: do we have all the evidence?. Asian J Androl 2015;17:335

How to cite this URL:
Ghazi A. Extended lymph node dissection for intermediate and high-risk prostate cancer: do we have all the evidence?. Asian J Androl [serial online] 2015 [cited 2019 Dec 16];17:335. Available from: http://www.ajandrology.com/text.asp?2015/17/2/335/143042 - DOI: 10.4103/1008-682X.143042

In the article "extended lymph node dissection in robot-assisted radical prostatectomy: lymph node yield and distribution of metastases" published on Asian Journal of Andrology, Kim et al. [1] present their robot-assisted experience for an extended pelvic lymph node dissection (E-PLND) in the management of intermediate and high-risk prostate cancer patients. The reported lymph node yield and positivity is comparable to literature published in robot-assisted and open approaches for radical prostatectomy. [2] Increasing reports of a decline in the incidence of lymph node dissection, [3] have questioned the adequacy of an E-PLND performed through the robot-assisted approach. Furthermore claims that surgical modality may be a factor in determining the adequacy of a lymph node dissection during prostate cancer surgery have emerged. This manuscript presents a legitimate argument against both claim. In addition, the authors also highlight a high incidence of positive lymph nodes at the internal iliac and common iliac areas highlights that the extent of lymph node dissection is more important than the absolute number of lymph nodes removed during E-PLND. Variations in the extents of an E-PLND template and differences in guidelines for the indications of such dissections may have also been the contributing to the discrepancy in the utilization of an E-PLND. E-PLND offers increased accuracy in detecting occult lymph node metastases when compared to standard lymph node dissections. [2],[4] This is emphasized by the finding of single positive nodes at the internal iliac area in 20% of the patients studied. Several studies have also reported improved survival following an extended template dissection. [5],[6] Nevertheless applying an extended template of lymphadenectomy is associated with an increased risk of morbidity, namely lymphocele, nerve and vessel injury. However, several reports associate worse potency outcomes following an E-PLND, [7] these potency outcomes remain underreported.

The manuscript has established that the robotic technique is not a prohibitive factor in performing E-PLND. It is essential to reach a consensus on the extent of a lymphadenectomy covering all primary-landing sites of prostate cancer. Furthermore, there is a need for randomized trials determining which patients would most benefit from an extended lymphadenectomy in high-risk prostate cancer.

 
  References Top

1.
Kim KH, Lim SK, Koo KC, Han WK, Hong SJ, et al. Extended lymph node dissection in robot-assisted radical prostatectomy: lymph node yield and distribution of metastases. Asian J Androl 2014; 16: 824-8.  Back to cited text no. 1
    
2.
Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, et al. Pelvic lymph node dissection in prostate cancer. Eur Urol 2009; 55: 1251-65.  Back to cited text no. 2
    
3.
Feifer AH, Elkin EB, Lowrance WT, Denton B, Jacks L, et al. Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy. Cancer 2011; 117: 3933-42.  Back to cited text no. 3
    
4.
Allaf ME, Palapattu GS, Trock BJ, Carter HB, Walsh PC. Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol 2004; 172: 1840-4.  Back to cited text no. 4
    
5.
Bader P, Burkhard FC, Markwalder R, Studer UE. Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol 2003; 169: 849-54.  Back to cited text no. 5
    
6.
Joslyn SA, Konety BR. Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology 2006; 68: 121-5.  Back to cited text no. 6
    
7.
Sagalovich D, Calaway A, Srivastava A, Sooriakumaran P, Tewari AK. Assessment of required nodal yield in a high risk cohort undergoing extended pelvic lymphadenectomy in robotic-assisted radical prostatectomy and its impact on functional outcomes. BJU Int 2013; 111: 85-94.  Back to cited text no. 7
    




 

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