Login to Access Video or Poster Abstract: MP47-11
Sources of Funding: None

Introduction

Standard extended pelvic lymph node dissection (ePLND) included the removal of external iliac, obturator and internal iliac chains. However, mapping studies demostrated that extending template up to the ureteric crossing would remove approximately 75% of all primary landing sites, and suggested to add presacral node dissection to ePLND, in order to correctly remove nodal metastases in 97% of patients. _x000D_ The aim of this study is to describe the frequency and distribution of metastases to pelvic nodes, in patients (Pts) with clinically localised, intermediate-high risk prostate cancer (PCa) according to the EAU guidelines, treated with radical prostatectomy and ePLND. _x000D_

Methods

We retrospectively evaluated 554 consecutive Pts with clinically localized, intermediate-high risk PCa, treated with open radical prostatectomy and ePLND between 2009 and 2015 at a single institution by multiple experienced surgeons. The ePLND always consisted of the external iliac, obturator, internal iliac, presacral and common iliac nodal site up to the ureteric crossing. Specimens from each anatomic site were sent in separate packets._x000D_

Results

The median number of removed nodes was 22 (range 9-61). Positive nodes (LN+) were found in 119 patients (21.4%). The mean and median number of positive nodes were 2.9 and 1 (range: 1-18), respectively. The median number of removed nodes was 6, 8, 5, 2, and 1 for external iliac, obturator, internal iliac, common iliac, and presacral site, respectively. _x000D_ Out of the 119 Pts, nodal metastases were found in 54 (45.4%), 50 (42%), 56 (47.1%), 12 (10.1%) and 15 (12.6%) in the external iliac, obturator, internal iliac, common iliac, and presacral sites, respectively. However, when analyzing the presence of positive nodes only in a single anatomic area, nodal metastases were present in 19 (16%), 18 (15.1%), 25 (21%), 0, and 3 (2%) in the external iliac, obturator, internal iliac, common iliac, and presacral site, respectively. _x000D_ A limited LND would have correctly staged 92 (77%) Pts and would have removed all LN+ in 37 (31%) Pts. An extended LND would have correctly staged 116 (97%) Pts but removed all LN+ in only 93 (78%) Pts. _x000D_

Conclusions

Internal iliac and presacral nodes harbored metastases in more than 60% of cases, and positive nodes were present only in these areas in 23% of cases. _x000D_ On the contrary, metastases at common iliac nodes were always associated with concomitant involvement of external iliac, obturator and/or internal iliac nodes._x000D_ An extended LND would have correctly staged 116 (97%) Pts but removed all LN+ in only 93 (78%) Pts. _x000D_

Funding

None