title: [Complications of pelvic lymphadenectomy in clinically localised prostate cancer: different techniques in comparison and dependency on the number of removed lymph nodes].
abstract: OBJECTIVE
  The EAU guidelines recommend extended pelvic lymphadenectomy (ePLND) or sentinel-guided PLND (SLNE) for lymph node (LN) stag-ing in prostate cancer. However, the additional expenditure and increased morbidity of ePLND has led to a limitation of the PLND area and so to a reduced detection of metastases in many clinics. The SLNE offers the advantage of selective removal of sentinel LN. Therefore, we have compared the complications of SLNE and other different PLND techniques.
  
  
  METHODS
  Patients with prostate cancer who had received an open PLND (PLND: n = 90, PLND + radical retropubic prostatectomy: n = 409) were assessed. The complications of three PLND techniques were compared: group 1 (n = 216): SLNE, group 2 (n = 117): SLNE + modified (m) PLND (fossa obturatoria- und Iliaca-externa-region), group 3 (n = 163): SLNE + ePLND (fossa obturatoria- + Iliaca-externa- + Iliaca-interna-region). The complications were evaluated with special reference to the PLND-induced morbidity (e. g., lymphoceles).
  
  
  RESULTS
  In SLNE the total complications were low-er than in the two more extended PLND variants. The lymphatic complications (11.2 %) were significant (χ (2) = 8.616, p = 0.013) lower than in SLNE + mPLND (21.2 %) and SLNE + ePLND (22.0 %). With an increasing number of dissected LN the complication rate increased significantly. If ≥ 15 LN have been removed total and lymphatic complications increased significantly (χ (2) = 11.578, p = 0.021; χ (2) = 12.271, p = 0.015).
  
  
  CONCLUSIONS
  In PLND the lymphatic complications increase significantly with the number of dissected LN. The SLNE has, in spite of the dissection of LN in difficultly accessible regions (presacral, iliaca-interna-region), a low complication rate. As a method with a small number of LN to be removed, the SLNE offers a good compromise between high sensitivity and low morbidity and is therefore preferable to the more extended PLND variants.
authors.affiliation: Klinik für Urologie und Kinderurologie, Klinikum Oldenburg. winter.alexander@klinikumoldenburg.de
authors.forename: A
authors.initials: A
authors.lastname: Winter
authors.forename: C
authors.initials: C
authors.lastname: Vogt
authors.forename: D
authors.initials: D
authors.lastname: Weckermann
authors.forename: F
authors.initials: F
authors.lastname: Wawroschek
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects / Q000379:methods