title: Diagnostic yield and complications of extended lymphadenectomy versus limited lymphadenectomy combined with radical prostatectomy.
abstract: BACKGROUND
  Lymphadenectomy for prostate cancer (PC) is the most reliable procedure for detecting lymphatic metastases. The optimal extension of this procedure is still a topic of debate.
  
  
  OBJECTIVE
  To analyse the diagnostic performance and complications of extended lymphadenectomy (ELD) and limited lymphadenectomy (LLD) in a series of patients with high-risk PC who underwent radical prostatectomy (RP).
  
  
  METHODS
  A retrospective study was conducted on patients with high d'Amico risk who underwent RP with lymphadenectomy between 1999 and 2014. A comparative analysis was performed of the diagnostic capacity of lymphatic metastases of ELD and LLD and of postoperative complications at 90 days.
  
  
  RESULTS
  Ninety-three patients were analysed, 20 (21.5%) and 73 (78.5%) of whom underwent ELD and LLD, respectively. The mean age of the series was 65.26 years (SD, 5.51). The median follow-up was 1.51 (0.61-2.29) years in the ELD group and 5.94 (3.61-9.10) in the LLD group. The median number of nodes obtained was 13 (9-23) in the ELD group compared with 5 (2-8) in the LLD group (p <.001). The percentages of patients with positive nodes in the ELD and LLD groups were 35% and 5.47%, respectively (p <.001). The overall complication rate at 90 days was 35.5% (33 patients). In the ELD group, 12 patients (60%) had complications, compared with 21 patients (28.8%) in the LLD group (p=.016), with no significant differences in severity according to the Clavien scale (p=.73).
  
  
  CONCLUSIONS
  In our series, the detection of metastatic nodes was significantly greater with ELD. ELD increases the number of complications, with no differences compared with LLD in severity according to the modified Clavien scale.
authors.affiliation: Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España. Electronic address: ana.guijarroc@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Guijarro
authors.affiliation: Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Reguero
authors.affiliation: Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: V
authors.initials: V
authors.lastname: Hernández
authors.affiliation: Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: J M
authors.initials: JM
authors.lastname: de la Morena
authors.affiliation: Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: De la Peña
authors.affiliation: Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: B
authors.initials: B
authors.lastname: López
authors.affiliation: Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: B
authors.initials: B
authors.lastname: Fernández
authors.affiliation: Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Parrilla
authors.affiliation: Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Pérez-Fernández
authors.affiliation: Servicio Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: I
authors.initials: I
authors.lastname: Alemany
authors.affiliation: Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Llorente
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D003949:Diagnostic Techniques, Surgical; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies
keywords: Cáncer de próstata de alto riesgo; Extended lymphadenectomy; High-risk prostate cancer; Limited lymphadenectomy; Linfadenectomía ampliada; Linfadenectomía limitada; Prostatectomía radical; Radical prostatectomy