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Optimization of Extended Pelvic Lymph Node Dissection Side for Prostate Cancer
Masaki Shiota1, Masaki Shimbo2, Shigehiro Tsukahara3
1Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. shiota.masaki.101@m.kyushu-u.ac.jp.
Annals of Surgical Oncology
|September 28, 2024
Summary
This study shows tumor location-guided extended pelvic lymph node dissection (ePLND) accurately detects positive lymph nodes in prostate cancer. This approach optimizes unilateral ePLND, potentially reducing the need for bilateral procedures.
Area of Science:
- Urology
- Oncology
- Surgical Oncology
Background:
- Prostate cancer staging relies on accurate lymph node assessment.
- Extended pelvic lymph node dissection (ePLND) is crucial for staging but can be bilateral.
- Optimizing ePLND side selection can improve patient outcomes and reduce morbidity.
Purpose of the Study:
- To determine the association between prostate tumor location and the laterality of positive lymph nodes.
- To evaluate the efficacy of tumor location-guided extended pelvic lymph node dissection (ePLND).
- To optimize unilateral ePLND for prostate cancer management.
Main Methods:
- Retrospective analysis of patients undergoing robot-assisted radical prostatectomy with ePLND.
- Tumor localization using biopsy and magnetic resonance imaging (MRI) findings.
- Evaluation of tumor location-guided unilateral ePLND for positive lymph node detection accuracy.
Main Results:
- Tumor locations were unilateral in 74.1% and bilateral in 23.3% of 301 patients.
- Tumor location-guided unilateral ePLND achieved 99.6% accuracy for detecting any positive lymph nodes.
- High accuracies (99.0% and 97.3%) were observed in independent patient cohorts.
Conclusions:
- Tumor location-guided ePLND is a viable strategy for prostate cancer.
- This approach enables optimized unilateral ePLND, reducing surgical burden.
- Acceptable risk of missing positive lymph nodes may be balanced against reduced bilateral dissection.
