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Updated: Jun 5, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging
Karim Touijer1, Rodrigo Pinochet Fuenzalida, Farhang Rabbani
1Department of Surgery, Service of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. touijera@mskcc.org
Objective:
• To assess, in a risk/benefit analysis, the additional risk for complications and benefits of extending the indications and anatomical limits of pelvic lymph node dissection (PLND).
Patients And Methods:
• In total, 971 consecutive patients with clinically localized prostate cancer underwent laparoscopic radical prostatectomy from 2003-2007. • Before 1 February 2005, patients with a nomogram probability of lymph node invasion (LNI) <2% did not undergo PLND (No PLND group), whereas those with a LNI ≥ 2% had a PLND limited to the external iliac nodal group (limited PLND group). • After 1 February 2005, all patients underwent a standard PLND including the external iliac, hypogastric and obturator fossa nodal groups (standard PLND group). • The risk parameters were PLND-related complications and operating time. Complications were graded using a modified Clavien classification. The benefit was the detection of nodal metastases.
Results:
• In the subgroup of patients with a LNI ≥ 2%, standard PLND was a superior operation than the limited PLND in detecting nodal metastases (14.3% vs 4.5%, respectively; P = 0.003). • The risk/benefit of standard vs limited PLND would be one additional grade 3 complication per 20 additional patients with nodal metastases. In the subgroup of patients with LNI <2%, three patients (1.0%) had positive nodes after a standard PLND. • The risk/benefit of standard PLND vs no PLND would be one additional grade 3 complication per three or four additional patients with nodal metastasis. The no PLND group was associated with the lowest risk of grade 1, 2 and 3 complications compared to either the limited or standard PLND groups (P < 0.001).
Conclusions:
• In patients with LNI ≥ 2%, standard PLND detects more nodal metastasis. PLND is associated with higher but non-prohibitive complications rate. • The present study found no evidence that the incidence of complications would be reduced by a limited PLND.
