COMPARISON OF TWO TEMPLATES OF LYMPHADENECTOMY IN PATIENTS AFFECTED BY HIGH RISK PROSTATE CANCER

Roberto Sanseverino1, Giorgio Napodano1, Olivier Intilla1, Umberto Di Mauro1, Giovanni Molisso1, Antonio Pistone1, Tommaso Realfonso1
  • 1 Ospedale Umberto I - ASL Salerno, U.O.C. Urologia (Nocera Inferiore)

Objective

High risk prostate cancer treatment considers an extended lymphadenectomy. We have compared two templates of pelvic lymphadenectomy in high risk patients undergone an extraperitoneal or transperitoneal laparoscopic radical prostatectomy.

Materials and Methods

Two consecutive series of patients affected by high risk prostate cancer underwent laparoscopic radical prostatectomy. In group 1 (116 pts), the procedure was realized by a preperitoneal access with an extended lymphadenectomy including external iliac and obturator nodes; in group 2 (35 pts), access was transperitoneal with a broader lymphadenectomy consisting of common iliac, external iliac, hypogastric and obturator nodes. We have compared perioperative outcomes in terms of number of nodes removed, positive nodes, complications in the two groups of patients. Statistical analysis has been realized using SPSS 24

Results

Data on 151 patients were analyzed. Baseline characteristics are reported in table 1. Preoperative data were balanced between two groups of patients except for biopsy Gleason score. Postoperative outcomes are listed in table 2: Group 2 patients presented worse pathological stage, longer operative time, more nodes removed (mean 33.3 vs 16.6, p<0.001) and more positive pathological nodes (22.9 vs 1.7%, p<0.001). Moreover, a wider lymphadenectomy template was not associated to greater risk of complications or lymphocele.

Discussions

Pelvic lymphadenectomy remains the gold standard for providing a diagnosis of lymph node metastasis in prostate cancer patients. A limited lymph¬adenectomy to the obturator fossa was the standard technique until a few years ago when it was replaced by extended lymphadenectomy. We describe our experience in two consecutive series of high risk patients undergone to two lymphadenectomy templates. Preoperative were balanced between two groups of patients except for biopsy Gleason score that resulted higher in the second group. Regarding postoperative outcomes, Group 2 patients presented worse pathological stage, longer operative time, but also more nodes removed (mean 33.3 vs 16.6 p<0.001) and more positive pathological nodes (28.0 vs 1.7%, p<0.001).
Moreover, a wider lymphadenectomy template was not associated to greater risk of any complications or lymphocele. Increasing the NLN may have a therapeutic effect on the outcome of prostate cancer, but this feature needs more documentation. Our study cannot evaluate this issue.

Conclusion

In our retrospective analysis, atransperitoneal laparoscopic radical prostatectomy with an extended lymphadenectomy template including obturator, external iliac, common iliac and hypogastric nodes allows to remove a greater number of nodes, to obtain a more positive nodes without increasing risk of complications.

Reference

Annals of Oncol 2013; 24: 1459-66

Eur Urol 2014; 65: 20-25

Eur Urol 2009; 55: 1251-65

Eur Urol 2008; 53: 118-125

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