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Adverse Effects and Functional Outcome after Salvage Lymph Node Dissection in Prostate Cancer.

Ruth Himmelsbach1, Julia Franz2, August Sigle2,3

  • 1Department of Urology, Faculty of Medicine, University of Freiburg - Medical Center, Freiburg, Germany, ruth.himmelsbach@uniklinik-freiburg.de.

Oncology Research and Treatment
|October 23, 2025
PubMed
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Salvage lymph node dissection (sLND) for recurrent prostate cancer has high complication rates (67%) and potential functional impairments like incontinence. Discuss these risks with patients before considering this metastasis-directed therapy.

Area of Science:

  • Urology
  • Oncology
  • Surgical Oncology

Background:

  • Nodal recurrence of prostate cancer after primary therapy necessitates treatment options.
  • Salvage lymph node dissection (sLND) is a metastasis-directed treatment for selected patients.
  • Prior multimodal therapy, including radiation, complicates sLND outcomes.

Purpose of the Study:

  • To assess postoperative complications and functional outcomes after sLND in patients with recurrent prostate cancer.
  • To standardize the evaluation of results following sLND in a multimodal setting.
  • To identify predictors of complications and functional deficits post-sLND.

Main Methods:

  • Retrospective analysis of 173 patients undergoing sLND between 2005-2019.
  • Complications graded using Clavien-Dindo-Classification (CDC).
Keywords:
ComplicationsFunctional outcomeLymph node metastasesMetastasis-directed therapyProstate cancer relapseSalvage lymphadenectomy

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  • Quality of life (QoL) assessed via EORTC QLQ-C30; incontinence via pad usage and ICIQ-SF.

    • Main Results:

    • High any-grade complication rate (67%), with 31% severe (CDC grade ≥IIIa).
    • Increased lymph node yield associated with any complications; higher metastasis count with severe complications.
    • 56% of patients were pad-free post-sLND; prior radiation and radical prostatectomy predicted incontinence.

    Conclusions:

    • sLND is a viable option for selected patients with nodal-recurrent prostate cancer.
    • Significant complication rates and functional impairments (e.g., incontinence) are associated with sLND.
    • Informed patient discussion regarding risks and benefits is crucial for indication balancing.