Lymph node parameters and complications following laparoscopic extended pelvic lymphadenectomy for prostate cancer in 1000 consecutive patients

Abstract

Objective:

The purpose of this study was to investigate the short-term results of extended pelvic lymphadenectomy (ePLND) during laparoscopic radical prostatectomy (LRP).

Patients and methods:

Of 1330 consecutive patients undergoing LRP during a 90-month period 1000 (75%) had an ePLND for d’Amico intermediate- or high-risk prostate cancer.

Results:

Operating time, blood loss, conversion and transfusion rates and hospital stay were similar in patients having standard pelvic lymphadenectomy (sPLND) and ePLND. Median lymph node count was significantly greater following ePLND vs sPLND (17 vs 6; p⩽0.0001). Complication rates were also similar but trended (p=0.06) towards a greater rate after ePLND vs sPLND: 9.0% and 5.5%. Lymph node involvement (LNI) was detected more frequently following ePLND in patients with: prostate specific antigen (PSA)=0–9.9 (p=0.01) and PSA=10–19.9 (p⩽0.0001); biopsy Gleason sum ⩽8 (p⩽0.0001 to 0.03); intermediate- (p⩽0.0001) and high-risk (p⩽0.0001) cancer; pathological Gleason grade 7 (p⩽0.0001) and pathological stage T3 (p=0.0009 for pT3a and p⩽0.0001 for pT3b).

Conclusion:

ePLND is a more effective tool than sPLND in detecting LNI for patients in all prognostic clinical groups. This can be achieved without significant penalty with respect to operating time or complication rates.