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

The goal of our study was to generate a standardized assessment of postoperative complications and functional results in patients undergoing salvage lymph node dissection (sLND) in a multimodal setting with prior primary therapy and possibly multiple courses of radiation due to nodal-recurrent prostate cancer.

This study included 173 patients that underwent sLND between 2005 and 2019. Postoperative complications were reported according to Clavien-Dindo-Classification (CDC). Health-related quality of life (QoL) was assessed prospectively using a validated questionnaire (EORTC QLQ-C30). Postoperative urinary incontinence was quantified with the assessment of pad usage and the ICIQ-SF questionnaire.

The any-grade complication rate after sLND was 67% (n = 115 patients). A total of patients (n = 42) had severe postoperative complications (CDC grade ≥IIIa). No grade V complications were reported. The number of lymph nodes removed was higher in patients with any-grade complications (median 32 versus 25, p = 0.03), while the number of lymph node metastases was higher in patients with severe complications (median 7 versus 3, p = 0.03). However, no clinical parameter was independently associated with complications. A total of 56% patients did not require any pads postoperatively. Median postoperative ICIQ-SF score was 5 and was higher in patients with any prior radiation (median 6 versus 0, p = 0.03). Radical prostatectomy as primary therapy (p = 0.01) and any prior radiation (p = 0.01) were independent predictors of any incontinence. Patients' QoL was rated as moderate, with an impairment in QoL in 39% of the follow-up cohort.

SLND is a treatment option in selected patients with nodal-recurrent prostate cancer with considerable complication rates and possible functional impairments that need to be discussed with the patient when balancing the indication for this metastasis-directed treatment option.