Mp58-20 Impact of Extended vs Limited Pelvic Lymph Node Dissection on Biochemical Recurrence in Intermediate and High-Risk Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP58)1 May 2024MP58-20 IMPACT OF EXTENDED VS LIMITED PELVIC LYMPH NODE DISSECTION ON BIOCHEMICAL RECURRENCE IN INTERMEDIATE AND HIGH-RISK PROSTATE CANCER David E. Hinojosa-Gonzalez, Jose I. Nolazco, Gal Saffati, Shane Kronstedt, Jeffrey A. Jones, Dov Kadmon, Justin Badal, and Jeremy R. Slawin David E. Hinojosa-GonzalezDavid E. Hinojosa-Gonzalez , Jose I. NolazcoJose I. Nolazco , Gal SaffatiGal Saffati , Shane KronstedtShane Kronstedt , Jeffrey A. JonesJeffrey A. Jones , Dov KadmonDov Kadmon , Justin BadalJustin Badal , and Jeremy R. SlawinJeremy R. Slawin View All Author Informationhttps://doi.org/10.1097/01.JU.0001008852.83523.41.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic lymph node dissection (PLND) is frequently performed during radical prostatectomy for the management of clinically localized prostate cancer and has possible diagnostic and therapeutic benefits. PLND's extent is a subject of controversy. Although PLND is typically limited to the obturator fossa, known as limited PLND (lPLND), other authors have suggested increased nodal yield from the internal, external, and common iliac spaces, termed extended PLND (ePLND), to augment both the diagnostic and therapeutic benefits of PLND. Claimed benefits in biochemical recurrence of ePLND from retrospective and database studies have been contrasted with findings from randomized controlled trials that found no difference in BCR. This study aims to analyze available literature on the impact of extent of dissection with biochemical recurrence. METHODS: In October 2023, a PRISMA-compliant systematic review was performed to identify studies that evaluated the extent of PLND. Data was extracted independently by two authors. Data was analyzed using Review Manager 5.41. The results are presented as Hazard Ratios (HR) with 95% confidence intervals. RESULTS: Twelve studies were included, of which two were randomized controlled trials. Overall, the RCTs found no benefit of ePLND HR 1.03 0.92, 1.14, p=0.61, although one of the RCTs had similar dissected lymph node yields between groups. Aggregate analysis with ten additional retrospective studies found significant rates of decreased BCR 0.68 0.52, 0.88, p=0.003. Subgroup analysis by extent of dissection found that while studies resecting Obturator Fossa, Internal Iliac, and External Iliac nodes had no BCR benefit (HR 0.97 0.72, 1.32, p=0.86), dissections that additionally included the Common Iliac +/- Presacral had decreased BCR (HR 0.56 0.41, 0.75, p<0.0001). Bayesian network analysis highlights significant differences in BCR reduction between different dissection approaches, indicating the potential benefits of specific dissection templates. CONCLUSIONS: Available literature on the extent of PLND is limited in quantity, quality and variability of the template defining ePLND. Dissection of the common iliac and presacral nodes may be beneficial and patients with high ISUP may benefit the most from ePLND. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e955 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information David E. Hinojosa-Gonzalez More articles by this author Jose I. Nolazco More articles by this author Gal Saffati More articles by this author Shane Kronstedt More articles by this author Jeffrey A. Jones More articles by this author Dov Kadmon More articles by this author Justin Badal More articles by this author Jeremy R. Slawin More articles by this author Expand All Advertisement PDF downloadLoading ...