Investig Clin Urol.  2018 Mar;59(2):83-90. 10.4111/icu.2018.59.2.83.

Can pelvic node dissection at radical prostatectomy influence the nodal recurrence at salvage lymphadenectomy for prostate cancer?

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

• KMID: 2404976
• DOI: http://doi.org/10.4111/icu.2018.59.2.83

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.

Keyword

Lymph node excision; Neoplasm recurrence, local; Prostatic neoplasms; Recurrence; Salvage therapy

MeSH Terms

Drainage
Humans
Iliac Vein
Lymph Node Excision*
Neoplasm Recurrence, Local
Pathology
Prostate*
Prostate-Specific Antigen
Prostatectomy*
Prostatic Neoplasms*
Recurrence*
Retrospective Studies
Salvage Therapy
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Kaplan-Mein cancer specific survival probability of patients undergoing salvage lymph node dissection.

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