Pelvic lymph node dissection in prostate cancer.
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Pelvic lymph node dissection in prostate cancer. / Briganti, Alberto; Blute, Michael L; Eastham, James H; Graefen, Markus; Heidenreich, Axel; Karnes, Jeffrey R; Montorsi, Francesco; Studer, Urs E.
in: EUR UROL, Jahrgang 55, Nr. 6, 6, 2009, S. 1251-1265.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Pelvic lymph node dissection in prostate cancer.
AU - Briganti, Alberto
AU - Blute, Michael L
AU - Eastham, James H
AU - Graefen, Markus
AU - Heidenreich, Axel
AU - Karnes, Jeffrey R
AU - Montorsi, Francesco
AU - Studer, Urs E
PY - 2009
Y1 - 2009
N2 - CONTEXT: Pelvic lymph node dissection (PLND) is considered the most reliable procedure for the detection of lymph node metastases in prostate cancer (PCa); however, the therapeutic benefit of PLND in PCa management is currently under debate. OBJECTIVE: To systematically review the available literature concerning the role of PLND and its extent in PCa staging and outcome. All of the existing recommendations and staging tools determining the need for PLND were also assessed. Moreover, a systematic review was performed of the long-term outcome of node-positive patients stratified according to the extent of nodal invasion. EVIDENCE ACQUISITION: A Medline search was conducted to identify original and review articles as well as editorials addressing the significance of PLND in PCa. Keywords included prostate cancer, pelvic lymph node dissection, radical prostatectomy, imaging, and complications. Data from the selected studies focussing on the role of PLND in PCa staging and outcome were reviewed and discussed by all of the contributing authors. EVIDENCE SYNTHESIS: Despite recent advances in imaging techniques, PLND remains the most accurate staging procedure for the detection of lymph node invasion (LNI) in PCa. The rate of LNI increases with the extent of PLND. Extended PLND (ePLND; ie, removal of obturator, external iliac, hypogastric with or without presacral and common iliac nodes) significantly improves the detection of lymph node metastases compared with limited PLND (lPLND; ie, removal of obturator with or without external iliac nodes), which is associated with poor staging accuracy. Because not all patients with PCa are at the same risk of harbouring nodal metastases, several nomograms and tables have been developed and validated to identify candidates for PLND. These tools, however, are based mostly on findings derived from lPLND dissections performed in older patient series. According to these prediction models, a staging PLND might be omitted in low-risk PCa patients because of the low rate of lymph node metastases found, even after extended dissections (
AB - CONTEXT: Pelvic lymph node dissection (PLND) is considered the most reliable procedure for the detection of lymph node metastases in prostate cancer (PCa); however, the therapeutic benefit of PLND in PCa management is currently under debate. OBJECTIVE: To systematically review the available literature concerning the role of PLND and its extent in PCa staging and outcome. All of the existing recommendations and staging tools determining the need for PLND were also assessed. Moreover, a systematic review was performed of the long-term outcome of node-positive patients stratified according to the extent of nodal invasion. EVIDENCE ACQUISITION: A Medline search was conducted to identify original and review articles as well as editorials addressing the significance of PLND in PCa. Keywords included prostate cancer, pelvic lymph node dissection, radical prostatectomy, imaging, and complications. Data from the selected studies focussing on the role of PLND in PCa staging and outcome were reviewed and discussed by all of the contributing authors. EVIDENCE SYNTHESIS: Despite recent advances in imaging techniques, PLND remains the most accurate staging procedure for the detection of lymph node invasion (LNI) in PCa. The rate of LNI increases with the extent of PLND. Extended PLND (ePLND; ie, removal of obturator, external iliac, hypogastric with or without presacral and common iliac nodes) significantly improves the detection of lymph node metastases compared with limited PLND (lPLND; ie, removal of obturator with or without external iliac nodes), which is associated with poor staging accuracy. Because not all patients with PCa are at the same risk of harbouring nodal metastases, several nomograms and tables have been developed and validated to identify candidates for PLND. These tools, however, are based mostly on findings derived from lPLND dissections performed in older patient series. According to these prediction models, a staging PLND might be omitted in low-risk PCa patients because of the low rate of lymph node metastases found, even after extended dissections (
KW - Humans
KW - Male
KW - Biopsy, Needle
KW - Immunohistochemistry
KW - Lymph Node Excision methods
KW - Lymph Nodes pathology
KW - Lymphatic Metastasis
KW - Neoplasm Invasiveness pathology
KW - Neoplasm Staging methods
KW - Pelvis
KW - Predictive Value of Tests
KW - Prognosis
KW - Prostatectomy methods
KW - Prostatic Neoplasms mortality
KW - Risk Assessment
KW - Survival Analysis
KW - Humans
KW - Male
KW - Biopsy, Needle
KW - Immunohistochemistry
KW - Lymph Node Excision methods
KW - Lymph Nodes pathology
KW - Lymphatic Metastasis
KW - Neoplasm Invasiveness pathology
KW - Neoplasm Staging methods
KW - Pelvis
KW - Predictive Value of Tests
KW - Prognosis
KW - Prostatectomy methods
KW - Prostatic Neoplasms mortality
KW - Risk Assessment
KW - Survival Analysis
M3 - SCORING: Zeitschriftenaufsatz
VL - 55
SP - 1251
EP - 1265
JO - EUR UROL
JF - EUR UROL
SN - 0302-2838
IS - 6
M1 - 6
ER -
