Contemporary role of salvage lymphadenectomy in patients with recurrence following radical prostatectomy.
BACKGROUND
Prostate cancer (PCa) patients with isolated clinical lymph node (LN) relapse, limited to the regional and/or retroperitoneal LNs, may represent a distinct group of patients who have a more favorable outcome than men with progression to the bone or to other visceral organs. Some data indirectly denote a beneficial impact of pelvic LN dissection on survival in these patients.


OBJECTIVE
To provide an overview of the currently available literature regarding salvage LN dissection (SLND) in PCa patients with clinical relapse limited to LNs after radical prostatectomy (RP).


METHODS
A systematic literature search was conducted using the Medline, Embase, and Web of Science databases to identify original articles, review articles, and editorials regarding SLND. Articles published between 2000 and 2012 were reviewed and selected with the consensus of all the authors.


RESULTS
Contemporary imaging techniques, such as 11C-choline positron emission tomography and diffusion-weighted magnetic resonance imaging, appear to enhance the accuracy in identifying LN relapse in patients with biochemical recurrence (BCR) and after RP. In these individuals, SLND can be considered as a treatment option. The currently available data suggest that SLND can delay clinical progression and postpone hormonal therapy in almost one-third of the patients, although the majority will have BCR. An accurate and attentive preoperative patient selection may help improve these outcomes. The most frequent complication after SLND was lymphorrhea (15.3%), followed by fever (14.5%) and ileus (11.2%). It is noteworthy that all examined cohorts originated from retrospective single-institution series, with limited sample size and short follow-up. Consequently, the current findings cannot be generalized and warrant further investigation in future prospective trials.


CONCLUSIONS
The current data suggest that SLND represents an option in patients with disease relapse limited to the LNs after RP; however, more robust data derived from well-designed clinical trials are needed to validate the role of SLND in this selected patient population.


RESULTS
Salvage lymph node dissection (SLND) represents a treatment option in for patients with prostate cancer relapse limited to the lymph nodes; however, more robust data derived from well-designed clinical trials are needed to validate the role of SLND in this selected patient population.
Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA. Electronic address: firas.abdollah@gmail.com.
Firas
F
Abdollah
Department of Urology, Vita-Salute University, San Raffaele, Milan, Italy.
Alberto
A
Briganti
Department of Urology, Vita-Salute University, San Raffaele, Milan, Italy.
Francesco
F
Montorsi
Department of Urology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
Arnulf
A
Stenzl
Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
Christian
C
Stief
Service d'Urologie, Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium.
Bertrand
B
Tombal
Department of Urology, Leuven Cancer Institute, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium.
Hein
H
Van Poppel
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Karim
K
Touijer
D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery* / Q000628:therapy; D049268:Positron-Emission Tomography; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D016879:Salvage Therapy / Q000379:methods*
Lymph node excision; Lymphatic metastasis; Neoplasm recurrence; Prostate-specific antigen/blood; Prostatectomy; Prostatic neoplasms/surgery; Salvage therapy; Treatment outcome; local/surgery