Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer.
OBJECTIVE
More-extensive pelvic lymph node dissection (PLND) may be associated with a higher rate of complications and a longer hospital stay than more limited PLND.


METHODS
Before radical retropubic prostatectomy, PLNDs were performed in 963 patients. Of these, 767 (79.6%) had >or=10 lymph nodes removed and examined (extended PLND [ePLND]), while 1-9 nodes (limited PLND [lPLND]) were removed in the remaining 196 (20.4%). Limits included external iliac, obturator, internal iliac, and iliac bifurcation. PLND-related complications and the length of hospital stay were recorded prospectively and analyzed according to the extent of PLND.


RESULTS
In patients subjected to ePLND, the overall rate of complications was 19.8% versus 8.2% in those treated with lPLND (p<0.001). In individual analyses of specific complications, only the lymphocele rate was significantly higher after ePLND (10.3% vs 4.6%; p=0.01). Similarly, ePLND translated into a longer hospital stay (9.9 vs 8.2 d; p<0.001). These differences persisted when adjustment was made for prostate-specific antigen and either clinical or pathologic tumor characteristics.


CONCLUSIONS
Our data indicate that, even in the hands of experienced urologic surgeons, ePLNDs are associated with higher complication rates and longer hospital stay. These detriments need to be taken into account when the staging benefit associated with ePLND is considered.
Briganti
Alberto
A
Department of Urology, Vita-Salute University, Milan, Italy.
Chun
Felix K-H
FK
Salonia
Andrea
A
Suardi
Nazareno
N
Gallina
Andrea
A
Da Pozzo
Luigi Filippo
LF
Roscigno
Marco
M
Zanni
Giuseppe
G
Valiquette
Luc
L
Rigatti
Patrizio
P
Montorsi
Francesco
F
Karakiewicz
Pierre I
PI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications; D011471:Prostatic Neoplasms / Q000473:pathology*; D012372:ROC Curve