A more extended lymph node dissection template at radical prostatectomy detects metastases in the common iliac region and in the fossa of Marcille

To assess the effect of adding lymph nodes (LN) located along the common iliac vessels and in the fossa of Marcille to the extended pelvic lymph node dissection (PLND) template at radical prostatectomy (RP).

At a referral center, RP and PLND were undergone by 485 patients from 2000 to 2008 (historical cohort: classical extended PLND template) and 268 patients from 2010 to 2015 (contemporary cohort: extended PLND template including LN located along the common iliac vessels and in the fossa of Marcille). Descriptive analyses compared baseline, pathologic, complication and functional data between the two cohorts. A logistic regression model assessed the template's effect on probability of detecting LN metastases.

Among 80 pN+ patients in the historical cohort, sole location of metastasis was external iliac/obturator fossa in 23 (29%), and internal iliac in 18 (23%), while 39 (49%) had metastases in both locations. Among 72 pN+ patients in the contemporary cohort, sole location of metastasis was external iliac/obturator fossa in 17 (24%), internal iliac in 24 (33%), and common iliac in 1 (1%), while 30 (42%) had metastases in >1 location (including fossa of Marcille in 5 patients). Among all 46 patients in the contemporary cohort with ≤2 metastases, 3 had one or both metastases in the common iliac region or the fossa of Marcille. Adjusted probability of detecting LN metastases was higher, but not significantly so, in the contemporary cohort. There were no differences between the two cohorts in complication and functional outcomes.

A more extended template detects LN metastases in the common iliac region and the fossa of Marcille and is not associated with a higher risk of complications. However, the overall probability of detecting LN metastases was not significantly higher. This article is protected by copyright. All rights reserved.

BJU international. 2017 Aug 21 [Epub ahead of print]

Lydia Maderthaner, Marc A Furrer, Urs E Studer, Fiona C Burkhard, George N Thalmann, Daniel P Nguyen

Department of Urology, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.

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