Radiation after pelvic lymphadenectomy: effect on morbidity

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• Staging pelvic lymph node dissection (PLND) morbidity is a concern, particularly when combined with radiation therapy for prostate cancer.
• The necessity and safety of PLND before definitive treatment require further investigation.

Purpose of the Study:

• To evaluate the morbidity associated with staging pelvic lymphadenectomy in patients with clinically localized prostate adenocarcinoma.
• To determine if definitive radiation therapy increases postoperative complications following PLND.

Main Methods:

• Forty-nine patients with clinically localized prostate adenocarcinoma underwent staging pelvic lymphadenectomy.
• Frozen section analysis was used for clinically suspected lymph nodes.
• Patients were stratified based on unilateral or bilateral dissection and subsequent treatment (radiation therapy, androgen deprivation, or hormonal manipulation).

Main Results:

• A 19% complication rate was observed in patients undergoing bilateral PLND, irrespective of subsequent radiation therapy.
• Complications included seromas, atelectasis, prolonged ileus, wound infection, and transient edema.
• No intraoperative or postoperative complications were noted in the 7 patients who underwent unilateral dissection.

Conclusions:

• Staging pelvic lymphadenectomy is a safe procedure for clinically localized prostate adenocarcinoma.
• Definitive radiation therapy does not appear to increase postoperative morbidity following pelvic lymphadenectomy.