UROLOGICAL ONCOLOGY

Complications and Other Surgical Outcomes Associated with Extended Pelvic Lymphadenectomy in Men with Localized Prostate Cancer
Briganti A, Chun FK, Salonia A, Suardi N, Gallina A, Da Pozzo LF, Roscigno M, Zanni G, Valiquette L, Rigatti P, Montorsi F, Karakiewicz PI
Department of Urology, Vita-Salute University, Milan, Italy
Eur Urol. 2006; 50: 1006-13

• Objectives: More-extensive pelvic lymph node dissection (PLND) may be associated with a higher rate of complications and a longer hospital stay than more limited PLND.
• Methods: Before radical retropubic prostatectomy, PLNDs were performed in 963 patients. Of these, 767 (79.6%) had >or=10 lymph nodes removed and examined (extended PLND [ePLND]), while 1-9 nodes (limited PLND [lPLND]) were removed in the remaining 196 (20.4%). Limits included external iliac, obturator, internal iliac, and iliac bifurcation. PLND-related complications and the length of hospital stay were recorded prospectively and analyzed according to the extent of PLND.
• Results: In patients subjected to ePLND, the overall rate of complications was 19.8% versus 8.2% in those treated with lPLND (p<0.001). In individual analyses of specific complications, only the lymphocele rate was significantly higher after ePLND (10.3% vs 4.6%; p=0.01). Similarly, ePLND translated into a longer hospital stay (9.9 vs 8.2 d; p < 0.001). These differences persisted when adjustment was made for prostate-specific antigen and either clinical or pathologic tumor characteristics.
• Conclusions: Our data indicate that, even in the hands of experienced urologic surgeons, ePLNDs are associated with higher complication rates and longer hospital stay. These detriments need to be taken into account when the staging benefit associated with ePLND is considered.
  
  
• Editorial Comment
  This is a timely article suitable into the actual discussion on the extend of lymph node dissection in radical prostatectomy (RP). The authors state clearly that extended lymph node dissection (eLND) leads to more complications and prolongs hospital stay. Therefore they caution against a too generous use of eLND before the benefits of this approach is clearly established.
  Lymphoceles occurred in 10.3% vs. 4.6% of patients and blood loss was higher in eLND (median 1200 mL) vs. Limited LND (median 1000 mL). The drawbacks of this article are its obvious retrospective approach and the very few numbers of lymph nodes in both arms (median 7 in the “limited” vs. 17 in the “extended” LND).

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: aboehle@badschwartau.helios-kliniken.de