Extended pelvic lymphadenectomy for prostate cancer: will the previously reported benefits be reproduced in hospitals with lower surgical volumes?
OBJECTIVE
In the European Association of Urology guidelines on prostate cancer an extended pelvic lymphadenectomy (ePLND) is now recommended, instead of a dissection limited to the obturator fossae (lPLND). This recommendation relies on studies reporting that metastatic disease is identified twice as often with ePLND as with lPLND, with only moderately increased complications. However, these studies were from high-volume centres. This study investigated whether these results could be repeated in a hospital with lower surgical volume, more typical for the Nordic countries.


METHODS
From January 2002 to September 2007 172 patients underwent radical prostatectomy and PLND at the University Hospital of Lund, 108 with ePLND and 64 with lPLND. Perioperative complications and the number of lymph-node metastases found were registered.


RESULTS
A median of 17 lymph nodes was identified with ePLND compared with seven with lPLND. Metastases were identified in four out of 64 patients in the lPLND group (6%), versus 22 out of 108 in the ePLND group (20%). In the ePLND group 10 of the patients with metastases had such exclusively outside the obturator fossae. Complications were significantly more common after ePLND (p=0.007): lymphoceles (18 vs 9%), pulmonary embolism (4.6 vs 1.6%), deep venous thrombosis (1 vs 1.5%) and other (haematomas and infectious including sepsis (8 vs 0%).


CONCLUSIONS
Almost half of the patients with metastases are misclassified by lPLND. Complications are significantly more common after ePLND. This implies that ePLND should be performed, but in selected patients and by high-volume surgeons only.
Lindberg
Christian
C
Department of Urology, Lund University Hospital, Lund, Sweden. christian.lindberg@skane.se
Davidsson
Thomas
T
Gudjónsson
Sigurdur
S
Hilmarsson
Rafn
R
Liedberg
Fredrik
F
Bratt
Ola
O
D002983:Clinical Competence; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008210:Lymphocele / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009664:Norway; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology