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Is a limited lymph node dissection an adequate staging procedure for prostate cancer?
Pia Bader1, Fiona C Burkhard, Regula Markwalder
1Department of Urology and Institute of Pathology, University of Berne, Berne, Switzerland.
The Journal of Urology
|July 20, 2002
Summary
Meticulous lymph node dissection is crucial for accurate prostate cancer staging. Dissecting internal iliac lymph nodes is essential, as omitting this step can lead to understaging in nearly a fifth of cases.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Lymph node dissection in prostate cancer is often limited to staging.
- The extent of lymph node dissection is frequently debated, with sampling sometimes suggested over complete dissection.
Purpose of the Study:
- To prospectively investigate lymph node metastasis patterns in prostate cancer.
- To determine the necessary extent of lymph node dissection to avoid understaging.
Main Methods:
- A prospective study evaluated 365 patients with clinically organ-confined prostate cancer undergoing radical prostatectomy.
- Meticulous lymph node dissection was performed along the external iliac vein, obturator nerve, and internal iliac (hypogastric) vessels.
- Nodes from each location were submitted separately for histological evaluation.
Main Results:
- Of 365 patients, 88 (24%) had positive lymph nodes.
- Internal iliac lymph nodes were positive in 51 (58%) of these patients.
- Positive internal iliac lymph nodes alone occurred in 17 (19%) of node-positive cases.
Conclusions:
- Significant lymph node metastases were found in all dissected areas.
- Dissection along internal iliac vessels is essential for accurate staging.
- Omitting internal iliac lymphadenectomy risks understaging over 20% of node-positive cases.