To evaluate whether indocyanine green guidance can improve the quality of extended pelvic lymph node dissection in patients undergoing radical prostatectomy.
A total of 214 patients underwent laparoscopic radical prostatectomy with indocyanine green-guided lymph node dissection plus extended pelvic lymph node dissection. These patients (group A) were matched 1:1 for clinical risk groups according to the National Comprehensive Cancer Network classification with patients who underwent the same procedure without fluorescence guidance (group B). Biochemical recurrence was defined as two consecutive prostate-specific antigen rises of at least 0.2 ng/mL. The Kaplan-Meier method and Cox regression models were used to identify predictors of biochemical recurrence.
The median number of retrieved nodes was significantly higher in group A (22 vs 14, P < 0.001). The rate of lymph node metastases was higher in group A (65.9% vs 34.1%, P = 0.01). Increasing the yield of lymph node dissection was independently and negatively correlated with the biochemical recurrence risk in both overall and pN-positive patients (hazard ratio 0.97, P = 0.03; and hazard ratio 0.95, P = 0.02). The 5-year biochemical recurrence-free survival rates were (75.8% vs 65.9, P = 0.09) and (54.1% vs 24.9%, P = 0.023) for group A and group B in the overall cohort and pN-positive cohort, respectively.
Indocyanine green-guided lymph node dissection plus extended pelvic lymph node dissection improves identification of lymphatic drainage, resulting in a higher number of lymph nodes and retrieved lymph node metastases, and allowing a more accurate local staging and a prolonged biochemical recurrence-free survival.
International journal of urology : official journal of the Japanese Urological Association. 2021 Mar 05 [Epub ahead of print]
Francesco Claps, Miguel Ramírez-Backhaus, Maria Carmen Mire Maresma, Álvaro Gómez-Ferrer, Juan Manuel Mascarós, Josè Marenco, Argimiro Collado Serra, Juan Casanova Ramón-Borja, Ana Calatrava Fons, Carlo Trombetta, Jose Rubio-Briones
Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain., Department of Pathology, Valencian Oncology Institute Foundation, FIVO, Valencia, Spain., Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.