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Extended pelvic lymph node dissection including internal iliac packet should be performed during robot-assisted laparoscopic radical prostatectomy for high-risk prostate cancer

Authors
 Jae Hung Jung  ;  Joo Wan Seo  ;  Meng Shi Lim  ;  Jae Won Lee  ;  Byung Ha Chung  ;  Sung Joon Hong  ;  Jae Mann Song  ;  Koon Ho Rha 
Citation
 JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, Vol.22(8) : 785-790, 2012 
Journal Title
 JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES 
ISSN
 1092-6429 
Issue Date
2012
MeSH
Aged ; Humans ; Lymph Node Excision/methods* ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Staging ; Proportional Hazards Models ; Prostatectomy/methods* ; Prostatic Neoplasms/mortality ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery* ; Robotics
Keywords
Aged ; Humans ; Lymph Node Excision/methods* ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Staging ; Proportional Hazards Models ; Prostatectomy/methods* ; Prostatic Neoplasms/mortality ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery* ; Robotics
Abstract
INTRODUCTION: The indication and anatomic limits of pelvic lymph node dissection (PLND) have not been clearly defined. Therefore, we assessed whether the extent of PLND at robot-assisted laparoscopic radical prostatectomy (RALP) had any benefit on lymph node yield, staging accuracy, and biochemical recurrence (BCR) in patients with high-risk prostate cancer. PATIENTS AND METHODS: Between July 2005 and July 2010, a retrospective analysis was performed on 200 patients with high-risk prostate cancer stratified by D'Amico classification. The study population was divided into different groups: patients in Group 1 had standard PLND, and Group 2 had extended PLND (ePLND). The clinicopathologic findings of patients and surgical outcomes of PLND with each procedure were measured. Kaplan-Meier and log rank tests were used to estimate BCR-free survival rates. Univariate and multivariate survival analyses were done with the Cox proportional hazard regression model. RESULTS: Medians of 15 (interquartile range, 11-19) and 24 (interquartile range, 18-28) lymph nodes were dissected in Groups 1 and 2, respectively (P<.001). The incidences of lymph node metastasis were 5.2% (8/155) in Group 1 and 22.2% (10/45) in Group 2. Regardless of the extent of PLND, the patients with positive lymph nodes had a significantly lower BCR-free survival than those with negative lymph nodes. Twenty-five percent (7/27) of positive lymph nodes were in the internal iliac packet and common iliac packet. In particular, of the positive internal iliac nodes, 75% (3/4) of nodes were found in that location, exclusively. CONCLUSIONS: An ePLND that identifies patients with lymph node metastasis including the internal iliac packet during RALP provides an accurate pathologic staging and may have survival benefits in high-risk prostate cancer.
Full Text
http://online.liebertpub.com/doi/abs/10.1089/lap.2011.0516
DOI
22967037
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Seo, Joo Wan(서주완)
Lee, Jae Won(이재원)
Chung, Byung Ha(정병하) ORCID logo https://orcid.org/0000-0001-9817-3660
Hong, Sung Joon(홍성준) ORCID logo https://orcid.org/0000-0001-9869-065X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/90937
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