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Extended pelvic lymphadenectomy for prostate cancer: Will the previously reported benefits be reproduced in hospitals with lower surgical volumes?

Lindberg, Christian LU ; Davidsson, Thomas LU ; Gudjonsson, Sigurdur LU ; Hilmarsson, Rafn; Liedberg, Fredrik LU and Bratt, Ola LU (2009) In Scandinavian journal of urology and nephrology Aug 25. p.437-441
Abstract
Objective. In the European Association of Urology guidelines on prostate cancer an extended pelvic lymphadenectomy (ePLND) is now recommended, instead of a dissection limited to the obturator fossae (lPLND). This recommendation relies on studies reporting that metastatic disease is identified twice as often with ePLND as with lPLND, with only moderately increased complications. However, these studies were from high-volume centres. This study investigated whether these results could be repeated in a hospital with lower surgical volume, more typical for the Nordic countries. Material and methods. From January 2002 to September 2007 172 patients underwent radical prostatectomy and PLND at the University Hospital of Lund, 108 with ePLND and 64... (More)
Objective. In the European Association of Urology guidelines on prostate cancer an extended pelvic lymphadenectomy (ePLND) is now recommended, instead of a dissection limited to the obturator fossae (lPLND). This recommendation relies on studies reporting that metastatic disease is identified twice as often with ePLND as with lPLND, with only moderately increased complications. However, these studies were from high-volume centres. This study investigated whether these results could be repeated in a hospital with lower surgical volume, more typical for the Nordic countries. Material and methods. From January 2002 to September 2007 172 patients underwent radical prostatectomy and PLND at the University Hospital of Lund, 108 with ePLND and 64 with lPLND. Perioperative complications and the number of lymph-node metastases found were registered. Results. A median of 17 lymph nodes was identified with ePLND compared with seven with lPLND. Metastases were identified in four out of 64 patients in the lPLND group (6%), versus 22 out of 108 in the ePLND group (20%). In the ePLND group 10 of the patients with metastases had such exclusively outside the obturator fossae. Complications were significantly more common after ePLND (p=0.007): lymphoceles (18 vs 9%), pulmonary embolism (4.6 vs 1.6%), deep venous thrombosis(1 vs 1.5%) and other (haematomas and infectious including sepsis (8 vs 0%). Conclusions. Almost half of the patients with metastases are misclassified by lPLND. Complications are significantly more common after ePLND. This implies that ePLND should be performed, but in selected patients and by high-volume surgeons only. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian journal of urology and nephrology
volume
Aug 25
pages
437 - 441
publisher
Taylor & Francis
external identifiers
  • WOS:000272559000001
  • PMID:19707953
  • Scopus:72049116305
ISSN
1651-2065
DOI
10.1080/00365590903200524
language
English
LU publication?
yes
id
71a6f1b5-4c66-4920-a1e7-98e65e57e681 (old id 1469300)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19707953?dopt=Abstract
date added to LUP
2009-09-07 15:41:21
date last changed
2016-11-18 11:24:00
@misc{71a6f1b5-4c66-4920-a1e7-98e65e57e681,
  abstract     = {Objective. In the European Association of Urology guidelines on prostate cancer an extended pelvic lymphadenectomy (ePLND) is now recommended, instead of a dissection limited to the obturator fossae (lPLND). This recommendation relies on studies reporting that metastatic disease is identified twice as often with ePLND as with lPLND, with only moderately increased complications. However, these studies were from high-volume centres. This study investigated whether these results could be repeated in a hospital with lower surgical volume, more typical for the Nordic countries. Material and methods. From January 2002 to September 2007 172 patients underwent radical prostatectomy and PLND at the University Hospital of Lund, 108 with ePLND and 64 with lPLND. Perioperative complications and the number of lymph-node metastases found were registered. Results. A median of 17 lymph nodes was identified with ePLND compared with seven with lPLND. Metastases were identified in four out of 64 patients in the lPLND group (6%), versus 22 out of 108 in the ePLND group (20%). In the ePLND group 10 of the patients with metastases had such exclusively outside the obturator fossae. Complications were significantly more common after ePLND (p=0.007): lymphoceles (18 vs 9%), pulmonary embolism (4.6 vs 1.6%), deep venous thrombosis(1 vs 1.5%) and other (haematomas and infectious including sepsis (8 vs 0%). Conclusions. Almost half of the patients with metastases are misclassified by lPLND. Complications are significantly more common after ePLND. This implies that ePLND should be performed, but in selected patients and by high-volume surgeons only.},
  author       = {Lindberg, Christian and Davidsson, Thomas and Gudjonsson, Sigurdur and Hilmarsson, Rafn and Liedberg, Fredrik and Bratt, Ola},
  issn         = {1651-2065},
  language     = {eng},
  pages        = {437--441},
  publisher    = {ARRAY(0x917d0b0)},
  series       = {Scandinavian journal of urology and nephrology},
  title        = {Extended pelvic lymphadenectomy for prostate cancer: Will the previously reported benefits be reproduced in hospitals with lower surgical volumes?},
  url          = {http://dx.doi.org/10.1080/00365590903200524},
  volume       = {Aug 25},
  year         = {2009},
}