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Predictive factors for lymph node positivity in patients undergoing extended pelvic lymphadenectomy during robot assisted radical prostatectomy.

Batra V, Gautam G, Jaipuria J, Suryavanshi M, Khera R, Ahlawat R - Indian J Urol (2015 Jul-Sep)

Bottom Line: However, there is no clear consensus on the selection criteria for subjecting patients to this additional procedure.The mean age of the patients was 65.5 (47-77) years and the body mass index was 26.3 (16.3-38.7) kg/m(2).The mean console time for EPLND was 45 (32-68) min.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Medanta - The Medicity, Gurgaon, India.

ABSTRACT

Introduction: Pelvic lymphadenectomy during radical prostatectomy (RP) improves staging and may provide a therapeutic benefit. However, there is no clear consensus on the selection criteria for subjecting patients to this additional procedure. With a growing adoption of robot assisted radical prostatectomy (RARP) in India, it has become imperative to study the incidence and predictive factors for lymph node involvement in our patients.

Materials and methods: From February 2010 to February 2014, 452 RARP procedures were performed at our institution. A total of 100 consecutive patients from July 2011 to August 2012 were additionally subjected to a robotic extended pelvic lymphadenectomy (EPLND). Lymph node positivity rates and lymph node density were analyzed on the basis of preoperative prostate specific antigen (PSA), Gleason score, clinical stage, D'Amico risk category and magnetic resonance imaging (MRI) findings. Multivariate analysis was performed to ascertain factors associated with lymph node positivity in our cohort.

Results: The mean age of the patients was 65.5 (47-77) years and the body mass index was 26.3 (16.3-38.7) kg/m(2). The mean console time for EPLND was 45 (32-68) min. A median of 17 (two to 40) lymph nodes were retrieved. Seventeen patients (17%) had positive lymph nodes (median of 1, range 1-6). Median lymph node density in these patients was 10%. When stratified by PSA, Gleason score, clinical stage, D'Amico risk category and features of locally advanced disease on MRI, a trend towards increasing incidence of lymph node positivity was observed, with an increase in adverse factors. However, on multivariate analysis, clinical stage > T2a was the only significant factor impacting lymph node positivity in our cohort.

Conclusions: A significant proportion of men undergoing RARP in India have positive lymph nodes on EPLND. While other variables may also have a potential impact, a higher clinical stage predisposes to an increased incidence of lymph node metastases.

No MeSH data available.


Related in: MedlinePlus

Intraoperative picture of robotic extended pelvic lymphadenectomy (right side) showing important anatomical landmarks and zones of dissection
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Figure 2: Intraoperative picture of robotic extended pelvic lymphadenectomy (right side) showing important anatomical landmarks and zones of dissection

Mentions: We perform EPLND as the initial step of RARP before creating the space of Retzius. The procedure entails the removal of lymph nodes and fibro fatty tissue in the external iliac, hypogastric and obturator regions [Figure 1]. The boundaries are the external iliac artery laterally, the bladder medially, the lymph node of Cloquet and circumflex branch of the external iliac vein distally, the endopelvic fascia caudally and the bifurcation of the common iliac artery proximally and cranially. At the end of the procedure, the obturator nerve and vessels, the external iliac vein and the hypogastric artery are completely cleared of the overlying tissue [Figure 2]. The obturator vessels may sometimes be sacrificed. Lymph nodes are sent in two separate packets (one for each side) for permanent section. Frozen section is performed only if there is evidence of bulky gross lymphadenopathy.


Predictive factors for lymph node positivity in patients undergoing extended pelvic lymphadenectomy during robot assisted radical prostatectomy.

Batra V, Gautam G, Jaipuria J, Suryavanshi M, Khera R, Ahlawat R - Indian J Urol (2015 Jul-Sep)

Intraoperative picture of robotic extended pelvic lymphadenectomy (right side) showing important anatomical landmarks and zones of dissection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495496&req=5

Figure 2: Intraoperative picture of robotic extended pelvic lymphadenectomy (right side) showing important anatomical landmarks and zones of dissection
Mentions: We perform EPLND as the initial step of RARP before creating the space of Retzius. The procedure entails the removal of lymph nodes and fibro fatty tissue in the external iliac, hypogastric and obturator regions [Figure 1]. The boundaries are the external iliac artery laterally, the bladder medially, the lymph node of Cloquet and circumflex branch of the external iliac vein distally, the endopelvic fascia caudally and the bifurcation of the common iliac artery proximally and cranially. At the end of the procedure, the obturator nerve and vessels, the external iliac vein and the hypogastric artery are completely cleared of the overlying tissue [Figure 2]. The obturator vessels may sometimes be sacrificed. Lymph nodes are sent in two separate packets (one for each side) for permanent section. Frozen section is performed only if there is evidence of bulky gross lymphadenopathy.

Bottom Line: However, there is no clear consensus on the selection criteria for subjecting patients to this additional procedure.The mean age of the patients was 65.5 (47-77) years and the body mass index was 26.3 (16.3-38.7) kg/m(2).The mean console time for EPLND was 45 (32-68) min.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Medanta - The Medicity, Gurgaon, India.

ABSTRACT

Introduction: Pelvic lymphadenectomy during radical prostatectomy (RP) improves staging and may provide a therapeutic benefit. However, there is no clear consensus on the selection criteria for subjecting patients to this additional procedure. With a growing adoption of robot assisted radical prostatectomy (RARP) in India, it has become imperative to study the incidence and predictive factors for lymph node involvement in our patients.

Materials and methods: From February 2010 to February 2014, 452 RARP procedures were performed at our institution. A total of 100 consecutive patients from July 2011 to August 2012 were additionally subjected to a robotic extended pelvic lymphadenectomy (EPLND). Lymph node positivity rates and lymph node density were analyzed on the basis of preoperative prostate specific antigen (PSA), Gleason score, clinical stage, D'Amico risk category and magnetic resonance imaging (MRI) findings. Multivariate analysis was performed to ascertain factors associated with lymph node positivity in our cohort.

Results: The mean age of the patients was 65.5 (47-77) years and the body mass index was 26.3 (16.3-38.7) kg/m(2). The mean console time for EPLND was 45 (32-68) min. A median of 17 (two to 40) lymph nodes were retrieved. Seventeen patients (17%) had positive lymph nodes (median of 1, range 1-6). Median lymph node density in these patients was 10%. When stratified by PSA, Gleason score, clinical stage, D'Amico risk category and features of locally advanced disease on MRI, a trend towards increasing incidence of lymph node positivity was observed, with an increase in adverse factors. However, on multivariate analysis, clinical stage > T2a was the only significant factor impacting lymph node positivity in our cohort.

Conclusions: A significant proportion of men undergoing RARP in India have positive lymph nodes on EPLND. While other variables may also have a potential impact, a higher clinical stage predisposes to an increased incidence of lymph node metastases.

No MeSH data available.


Related in: MedlinePlus