Extended pelvic lymph node dissection: Long way to 'optimal case selection'
BAUS ePoster online library. Panayi Z.
Jun 26, 2018; 211350
Zoe Panayi
Zoe Panayi
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Background: Extended pelvic lymph node dissection (EPLND) is performed with radical prostatectomy in patients at risk of LN metastases. This carries prognostic and therapeutic benefits, but also perioperative risks. The European Association of Urology recommends patient selection based upon a Briganti score of >5%, which predicts chance of LN metastasis. We aim to analyse the complications and histology outcomes, in patients selected for EPLND using the Briganti nomogram.

Method: Retrospective analysis of patients undergoing robotic EPLND from 2016 to 2017. Data included Briganti parameters, perioperative complications, and histology. Briganti score was calculated using both MRI and clinical T stage.

Results: EPLND was performed in 81 patients. Using D'Amico risk stratification, 88% were high, 11.1% intermediate and 1.2% low risk. Median Briganti score was 13% using clinical T stage and 18% with MRI stage. Mean LN yield was 17.7 (range 2-42). LN disease was found in 7 patients (8.6%), with Briganti scores of 9%, 23%, 49%, 60%, 22%, 75% and 66%. Intraoperatively, one patient had an external iliac vein tear repaired without consequence. 15 post-operative complications (18.5%) were identified. 5 patients developed a lymphocele (one requiring drainage), 1 pelvic haematoma, 1 deep vein thrombosis with pulmonary embolus, and 8 developed transient lymphoedema. Of these patients, two had LN positive disease.

Conclusion: EPLND is safe, with good LN yield, but is not without complications. In the absence of a randomised control trial, either a novel scoring tool or imaging with a higher specificity is required, to minimise unnecessary EPLND and its consequences.
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