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Pelvic lymph node dissection in prostate cancer staging: evaluation of morbidity and oncological outcomes.

Authors
  • Van Huele, Andries1
  • Poelaert, Filip1
  • Fonteyne, Valérie2
  • Decaestecker, Karel1
  • Ost, Piet2
  • Lumen, Nicolaas1
  • 1 a Department of Urology , Ghent University Hospital , Ghent , Belgium. , (Belgium)
  • 2 b Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium. , (Belgium)
Type
Published Article
Journal
Acta Chirurgica Belgica
Publisher
Informa UK (Taylor & Francis)
Publication Date
Apr 01, 2019
Volume
119
Issue
2
Pages
103–109
Identifiers
DOI: 10.1080/00015458.2018.1470294
PMID: 29734878
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To evaluate the morbidity of different surgical approaches for pelvic lymph node dissection (PLND), to evaluate the influence of morbidity on radiotherapy (RT) planning and to evaluate a possible therapeutic effect of a more extensive yield of PLND. From 2000-2016, 228 patients received staging PLND before primary RT in a single tertiary care center. Nine patients were excluded for the evaluation of morbidity. Fifty patients were operated in an open approach, 96 laparoscopic and 73 robot-assisted (RA). Clavien-Dindo classification was used for evaluating complications. Predictors of biochemical recurrence (BCR), clinical relapse (CR), cancer-specific survival (CSS) and overall survival (OS) were evaluated by regression analyses to determine a possible therapeutic effect. Minimal invasive surgery (laparoscopic or RA) caused five times less major complications (22% vs. 4.3%, p = .001) and a median 3 days shorter hospital stay (5 days versus 2 days, p < .001). Major complications resulted in a delayed (23 days, p < .001) RT start but no oncological effect was seen. Independent oncological predictors were the number of positive nodes (BCR, CR, CSS, OS), a lower age (CR), a higher level of initial prostate-specific antigen (PSA) (BCR) and post-RT PSA (BCR). Minimal invasive surgery can diminish major complications which delay RT start. Nodal staging proved to be of importance for prognosis but no therapeutic effect was seen of performing PLND as such.

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