Principles and Practice of Urooncology by Gokhan Ozyigit & Ugur Selek

Author:Gokhan Ozyigit & Ugur Selek
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

The lymph nodes that drain the lymphatic outflow of the prostate are external iliac-obturator (38%), internal iliac (25%), common iliac (16%), para-aortic/para-caval (12%), presacral (8%), and inguinal (1%) [56]. Indications for pelvic lymph node dissection (PLND) do not differ between robotic, laparoscopic, and open RPs. Therefore, if a PLND is indicated, then it should be done in the context of every RP, no matter what the surgical approach is. In other words, surgical approach preference should not preclude a PLND from being properly done in a patient who actually deserves it. EAU recommends an extended PLND in those intermediate-risk patients (cT2a, PSA 10–20 ng/mL, biopsy Gleason score 7) whose probability of lymph node involvement exceeds 5% on the Briganti nomogram and all high-risk patients (≥cT2b, PSA > 20 ng/mL, biopsy Gleason score ≥ 8) [12]. Extended PLND dissection field is bounded by the external iliac artery anteriorly, the pelvic side wall laterally, the bladder wall medially, the floor of the pelvis posteriorly, Cooper ligament distally, and the common iliac artery/ureter crossing proximally [57]. Several authors have reported the feasibility of an extended PLND during the course of RARP with a mean number of 12–19 lymph nodes being extracted and the positive node rates ranging from 11 to 24% [58, 59]. Transperitoneal and extraperitoneal RARP yielded similar results in terms of the lymph node yield. However, the risk of postoperative symptomatic lymphocele is higher with the extraperitoneal approach [35].

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