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Extended Pelvic Lymph Node Dissection Does Not Affect Functional Outcomes during Bilateral Nerve-Sparing Radical

Luise Krieger1, Sigrun Holze1, Meinhard Mende2,3

  • 1Department of Urology, University of Leipzig, Leipzig, Germany.

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Summary

Extended pelvic lymph node dissection (ePLND) during radical prostatectomy (RPE) does not negatively impact erectile function or continence recovery. This study found no increased risk of dysfunction or complications associated with ePLND in nerve-sparing RPE.

Keywords:
ContinencePelvic lymph node dissectionPotencyProstate cancerProstatectomy

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Area of Science:

  • Urology
  • Oncology
  • Surgical Outcomes

Background:

  • Radical prostatectomy (RPE) with extended pelvic lymph node dissection (ePLND) is a standard treatment for prostate cancer.
  • Concerns exist regarding potential negative impacts of ePLND on functional outcomes like erectile function (EF) and continence due to proximity to the pelvic plexus.
  • Previous studies have yielded conflicting results on the association between ePLND and functional recovery post-RPE.

Purpose of the Study:

  • To critically examine the association between ePLND and functional outcomes (EF and continence) in patients undergoing bilateral nerve-sparing RPE.
  • To determine if ePLND independently predicts for worse EF recovery or increased complications after RPE.

Main Methods:

  • Retrospective analysis of 272 patients from a randomized, multicenter trial undergoing bilateral nerve-sparing RPE.
  • Patients were classified into no PLND (114) or ePLND (158) groups based on D'Amico criteria.
  • Continence and EF (IIEF-5 score ≥17) were assessed at 3, 6, and 12 months; complications were graded using Clavien-Dindo Classification.

Main Results:

  • No significant difference in erectile function recovery (IIEF-5 ≥17: 23.2% vs. 27.2%; p=0.55) or sufficient erection for intercourse (44.1% vs. 45.6%; p=0.84) at 12 months between groups.
  • Preoperative EF, pathological tumor stage, and robot-assisted RPE were independent predictors of EF recovery, but ePLND was not.
  • No significant difference in continence recovery (94.2% vs. 89.7%; p=0.22) or overall complications (11.4% vs. 16.5%; p=0.24) between the groups.

Conclusions:

  • Extended pelvic lymph node dissection (ePLND) is not associated with an increased risk of erectile dysfunction after bilateral nerve-sparing radical prostatectomy (RPE).
  • ePLND does not negatively impact continence recovery or lead to a higher rate of surgical complications in this patient cohort.
  • Functional outcomes after nerve-sparing RPE are primarily predicted by preoperative factors and surgical technique, not the extent of lymph node dissection.