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Lymphatic spread of nodal metastases in high-risk prostate cancer: The ascending pathway from the pelvis to the retroperitoneum.

Authors :
Briganti A
Suardi N
Capogrosso P
Passoni N
Freschi M
di Trapani E
Gallina A
Capitanio U
Abdollah F
Tutolo M
Bianchi M
Salonia A
Da Pozzo LF
Montorsi F
Rigatti P
Source :
The Prostate [Prostate] 2012 Feb 01; Vol. 72 (2), pp. 186-92. Date of Electronic Publication: 2011 May 02.
Publication Year :
2012

Abstract

Background: The aim of this study was to map the nodal metastases distribution in patients with high-risk prostate cancer (PCa) treated with extended pelvic lymph node dissection (ePLND) and retroperitoneal lymph node dissection (rLND) at the time of radical prostatectomy (RP).<br />Materials and Methods: This prospective mapping study included 19 patients with high-risk PCa (sharing at least two out of the three following parameters: PSA >20 ng/ml, cT3, biopsy Gleason score ≥8). All patients were treated with RP, ePLND (removal of the obturator, hypogastric, external iliac, presacral, and common iliac lymph nodes) and rLND (removal of para-aortal/para-caval and inter-aorto-caval lymph nodes) by a single surgeon. All patients signed an informed consent highlighting the absence of clinical data supporting the benefit of this surgical approach.<br />Results: Overall, 18 out of 19 patients (94.7%) had pelvic lymph node invasion. The most commonly affected pelvic nodal landing site was obturator (88.8%), followed by external iliac (83.3%), common iliac (77%), hypogastric (44.4%), and presacral (33.3%). Moreover, 14 (77.8%) patients also had involvement of retroperitoneal lymph nodes. Only patients with positive common iliac lymph nodes having at least five positive lower pelvic lymph nodes (n = 14), also had invariably positive retroperitoneal lymph nodes. No patients with negative common iliac lymph nodes had positive retroperitoneal lymph nodes.<br />Conclusions: PCa lymphatic spread ascends from the pelvis up to the retroperitoneum invariably through common iliac lymph nodes. PCa lymphatic spread can be divided in two main levels: pelvic and common iliac plus retroperitoneal lymph nodes.<br /> (Copyright © 2011 Wiley Periodicals, Inc.)

Details

Language :
English
ISSN :
1097-0045
Volume :
72
Issue :
2
Database :
MEDLINE
Journal :
The Prostate
Publication Type :
Academic Journal
Accession number :
21538428
Full Text :
https://doi.org/10.1002/pros.21420