Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer

Travis Clark, Dipen J Parekh, Michael S. Cookson, Sam S. Chang, Ernest R. Smith, Nancy Wells, Joseph A. Smith

Research output: Contribution to journalArticle

213 Citations (Scopus)

Abstract

Purpose: The low rate of pelvic node metastasis in most contemporary series of patients undergoing radical prostatectomy for carcinoma of the prostate has been attributed to earlier and better patient selection than historical series. Alternatively, it has been suggested that the limited dissection commonly performed misses nodal metastasis in a substantial number of patients. To assess the value of an extended node dissection in detecting nodal metastasis, we performed a randomized prospective study. Materials and Methods: A total of 123 patients undergoing radical prostatectomy were randomized to an extended node dissection on the right versus the left side of the pelvis with the other side being a limited dissection. The extended dissection included removal of all external iliac nodes to a point above the bifurcation of the common iliac artery, the obturator nodes and the presacral nodes. The limited dissection included only the nodes along the external iliac vein and obturator nerve. Results: Mean patient age was 61 years. Clinical stage was T1c in 88 patients (72%), T2a in 26 (21%), T2b in 7 (6%) and T3 in 2 (1%). Mean preoperative prostate specific antigen was 7.4 ng./ml. Pelvic lymph node metastasis was histologically confirmed in 8 patients (6.5%). Positive nodes were found on the side of the extended dissection in 4 patients, on the side of the limited dissection in 3 and on both sides in 1. Complications possibly attributable to the node dissection included lymphocele in 4 patients, lower extremity edema in 5, deep venous thrombosis in 2, ureteral injury in 1 and pelvic abscess in 1. These complications occurred 3 times more often on the side of the extended dissection (p = 0.08). Conclusions: Extended node dissection in contemporary series of patients undergoing radical prostatectomy identifies few with nodal metastases not found by a more limited dissection. A trend toward an increased risk of complications attributable to the lymphadenectomy occurs with an extended dissection.

Original languageEnglish
Pages (from-to)145-147
Number of pages3
JournalJournal of Urology
Volume169
Issue number1
StatePublished - Jan 1 2003
Externally publishedYes

Fingerprint

Lymph Node Excision
Dissection
Prostatic Neoplasms
Neoplasm Metastasis
Prostatectomy
Obturator Nerve
Lymphocele
Iliac Vein
Iliac Artery
Prostate-Specific Antigen
Pelvis
Venous Thrombosis
Abscess
Patient Selection
Prostate
Lower Extremity
Edema
Lymph Nodes
Prospective Studies
Carcinoma

Keywords

  • Lymph node excision
  • Prostatectomy
  • Prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. / Clark, Travis; Parekh, Dipen J; Cookson, Michael S.; Chang, Sam S.; Smith, Ernest R.; Wells, Nancy; Smith, Joseph A.

In: Journal of Urology, Vol. 169, No. 1, 01.01.2003, p. 145-147.

Research output: Contribution to journalArticle

Clark, Travis ; Parekh, Dipen J ; Cookson, Michael S. ; Chang, Sam S. ; Smith, Ernest R. ; Wells, Nancy ; Smith, Joseph A. / Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. In: Journal of Urology. 2003 ; Vol. 169, No. 1. pp. 145-147.
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abstract = "Purpose: The low rate of pelvic node metastasis in most contemporary series of patients undergoing radical prostatectomy for carcinoma of the prostate has been attributed to earlier and better patient selection than historical series. Alternatively, it has been suggested that the limited dissection commonly performed misses nodal metastasis in a substantial number of patients. To assess the value of an extended node dissection in detecting nodal metastasis, we performed a randomized prospective study. Materials and Methods: A total of 123 patients undergoing radical prostatectomy were randomized to an extended node dissection on the right versus the left side of the pelvis with the other side being a limited dissection. The extended dissection included removal of all external iliac nodes to a point above the bifurcation of the common iliac artery, the obturator nodes and the presacral nodes. The limited dissection included only the nodes along the external iliac vein and obturator nerve. Results: Mean patient age was 61 years. Clinical stage was T1c in 88 patients (72{\%}), T2a in 26 (21{\%}), T2b in 7 (6{\%}) and T3 in 2 (1{\%}). Mean preoperative prostate specific antigen was 7.4 ng./ml. Pelvic lymph node metastasis was histologically confirmed in 8 patients (6.5{\%}). Positive nodes were found on the side of the extended dissection in 4 patients, on the side of the limited dissection in 3 and on both sides in 1. Complications possibly attributable to the node dissection included lymphocele in 4 patients, lower extremity edema in 5, deep venous thrombosis in 2, ureteral injury in 1 and pelvic abscess in 1. These complications occurred 3 times more often on the side of the extended dissection (p = 0.08). Conclusions: Extended node dissection in contemporary series of patients undergoing radical prostatectomy identifies few with nodal metastases not found by a more limited dissection. A trend toward an increased risk of complications attributable to the lymphadenectomy occurs with an extended dissection.",
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AU - Wells, Nancy

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N2 - Purpose: The low rate of pelvic node metastasis in most contemporary series of patients undergoing radical prostatectomy for carcinoma of the prostate has been attributed to earlier and better patient selection than historical series. Alternatively, it has been suggested that the limited dissection commonly performed misses nodal metastasis in a substantial number of patients. To assess the value of an extended node dissection in detecting nodal metastasis, we performed a randomized prospective study. Materials and Methods: A total of 123 patients undergoing radical prostatectomy were randomized to an extended node dissection on the right versus the left side of the pelvis with the other side being a limited dissection. The extended dissection included removal of all external iliac nodes to a point above the bifurcation of the common iliac artery, the obturator nodes and the presacral nodes. The limited dissection included only the nodes along the external iliac vein and obturator nerve. Results: Mean patient age was 61 years. Clinical stage was T1c in 88 patients (72%), T2a in 26 (21%), T2b in 7 (6%) and T3 in 2 (1%). Mean preoperative prostate specific antigen was 7.4 ng./ml. Pelvic lymph node metastasis was histologically confirmed in 8 patients (6.5%). Positive nodes were found on the side of the extended dissection in 4 patients, on the side of the limited dissection in 3 and on both sides in 1. Complications possibly attributable to the node dissection included lymphocele in 4 patients, lower extremity edema in 5, deep venous thrombosis in 2, ureteral injury in 1 and pelvic abscess in 1. These complications occurred 3 times more often on the side of the extended dissection (p = 0.08). Conclusions: Extended node dissection in contemporary series of patients undergoing radical prostatectomy identifies few with nodal metastases not found by a more limited dissection. A trend toward an increased risk of complications attributable to the lymphadenectomy occurs with an extended dissection.

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