Complications of pelvic lymphadenectomy in clinically localised prostate cancer: different techniques in comparison and dependency on the number of removed lymph nodes

• Published in: Aktuelle Urologie Vol. 42; no. 3; p. 179
• Main Authors: Winter, A, Vogt, C, Weckermann, D, Wawroschek, F
• Format: Journal Article
• Language: German
• Published: Germany 01-05-2011
• Subjects: Aged; Combined Modality Therapy; Cross-Sectional Studies; Diagnostic Imaging; Humans; Lymph Node Excision - adverse effects; Lymph Node Excision - methods; Lymphatic Metastasis - pathology; Male; Neoplasm Staging; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prognosis; Prostatectomy; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiotherapy, Adjuvant; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Sentinel Lymph Node Biopsy - adverse effects; Sentinel Lymph Node Biopsy - methods
• ISSN: 1438-8820
• DOI: 10.1055/s-0031-1271389

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.
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).
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).
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.