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171 Factors improving lymph node invasion detection during pelvic lymph node dissection for prostate cancer: Outcomes of 2160 lymph node dissections
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Factors improving lymph node invasion detection during pelvic lymph node dissection for prostate cancer: Outcomes of 2160 lymph node dissections Eur Urol Suppl 2016;15(3);e171
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Kyriazis I.1 , Do M. 1 , Dietel A. 1 , Ganzer R.1 , Alloussi S. 1 , Kallidonis P. 2 , Liatsikos E. 2 , Stolzenburg J.U. 1 1 University
of Leizig, Dept. of Urology, Leipzig, Germany, 2 University of Patras, Dept. of Urology, Patras, Greece
INTRODUCTION & OBJECTIVES: Apart from pelvic lymph node dissection (PLND) resection template other factors affecting the efficacy of PLND during radical prostatectomy (RP) are largely unknown. To review our large cohort of PLNDs and define factors that improve lymph node (LN) invasion (LNI) detection. MATERIAL & METHODS: Retrospective review of a prospective database including 2160 endoscopic (laparoscopic or robotic assisted) extraperitoneal or transperitoneal PLNDs performed between 2003-2014. For statistical analysis, Fisher’s exact test was used to test differences of LNI rates and t-test to compare mean LN yield among techniques. For multivariate analysis, LNI occurrence was modeled by a main-effects binary logistic regression model, where all examined variables (D’ Amico risk group, pT stage, RP access, robotic assistance, presence of inguinal hernia mesh, surgeon, LN yield) were introduced and next eliminated in a stepwise manner until no further variable removal provided a better fit to the data (backward selection). RESULTS: LNI detection and the percent of PLNDs revealing LN+ disease demonstrated a gradual increase throughout our study period. pT3 population of our cohort increased during the last years of the study paralleling the increase in LNI rates. Transperitoneal PLND was found superior than extraperitoneal in terms of revealing more LN+ patients when offered in similar risk stratified groups of patients. Robotic assistance demonstrated similar efficacy with conventional laparoscopic approach.
CONCLUSIONS: Surgical access (transperitoneal vs. extraperitoneal) and the ability to preoperatively identify high risk cases and more importantly pT3 cases that should undertake PLND have a major impact on the oncological outcomes of the approach. Other factors such as surgeon and the use of a robotic system did not effect the efficacy of lymphadenectomy.
Factors improving lymph node invasion detection during pelvic lymph node dissection for prostate cancer: Outcomes of 2160 lymph node dissections Eur Urol Suppl 2016;15(3);e171
Print! Print!
Kyriazis I.1 , Do M. 1 , Dietel A. 1 , Ganzer R.1 , Alloussi S. 1 , Kallidonis P. 2 , Liatsikos E. 2 , Stolzenburg J.U. 1 1 University
of Leizig, Dept. of Urology, Leipzig, Germany, 2 University of Patras, Dept. of Urology, Patras, Greece
INTRODUCTION & OBJECTIVES: Apart from pelvic lymph node dissection (PLND) resection template other factors affecting the efficacy of PLND during radical prostatectomy (RP) are largely unknown. To review our large cohort of PLNDs and define factors that improve lymph node (LN) invasion (LNI) detection. MATERIAL & METHODS: Retrospective review of a prospective database including 2160 endoscopic (laparoscopic or robotic assisted) extraperitoneal or transperitoneal PLNDs performed between 2003-2014. For statistical analysis, Fisher’s exact test was used to test differences of LNI rates and t-test to compare mean LN yield among techniques. For multivariate analysis, LNI occurrence was modeled by a main-effects binary logistic regression model, where all examined variables (D’ Amico risk group, pT stage, RP access, robotic assistance, presence of inguinal hernia mesh, surgeon, LN yield) were introduced and next eliminated in a stepwise manner until no further variable removal provided a better fit to the data (backward selection). RESULTS: LNI detection and the percent of PLNDs revealing LN+ disease demonstrated a gradual increase throughout our study period. pT3 population of our cohort increased during the last years of the study paralleling the increase in LNI rates. Transperitoneal PLND was found superior than extraperitoneal in terms of revealing more LN+ patients when offered in similar risk stratified groups of patients. Robotic assistance demonstrated similar efficacy with conventional laparoscopic approach.
CONCLUSIONS: Surgical access (transperitoneal vs. extraperitoneal) and the ability to preoperatively identify high risk cases and more importantly pT3 cases that should undertake PLND have a major impact on the oncological outcomes of the approach. Other factors such as surgeon and the use of a robotic system did not effect the efficacy of lymphadenectomy.