Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.
Urol Oncol. 2013 Nov;31(8):1517-21.e1-2. doi: 10.1016/j.urolonc.2012.04.021. Epub 2012 Jun 9.
To investigate the prevailing practice of uro-oncologists regarding the indications for and extent of pelvic lymph node dissection (PLND) for prostate cancer.
A 9-question survey was sent as a hyperlink by electronic mail to all members of the Society of Urologic Oncology. Participants were asked about their surgical volume, indications for PLND, which nodal packets are dissected as delineated on anatomical schema, and type of surgical approach.
Of 340 members, 183 urologists (58%) completed the survey. Of these, 43% were ≥ 10 years out of fellowship and 62% performed >50 radical prostatectomies per year. Of the surveyed surgeons, 45% performed PLND on all patients undergoing radical prostatectomy. The remainder used various risk-stratification schemas. A total of 32 different indications for PLND were reported, the most common being "intermediate risk" according to the American Urological Association's risk classification. As to extent of PLND, 15% perform a PLND limited to the external iliac, while 30% include the external iliac, obturator fossa, and hypogastric lymph nodes. Among surgeons using both open and robotic approaches, 19% reported that the indication for and extent of lymphadenectomy performed differ based on the surgical approach used.
The results of this survey provide insight into the practice patterns of uro-oncologists regarding PLND and highlight the lack of uniformity in determining when and how a PLND should be performed. Collaborative efforts are needed to develop guidelines on this issue and are a necessary step toward standardization of reporting the outcomes of surgical clinical trials.
调查泌尿外科肿瘤学家在前列腺癌盆腔淋巴结清扫术（PLND）的适应证和范围方面的现行实践。
通过电子邮件向泌尿肿瘤学会的所有成员发送了一个 9 个问题的调查链接。参与者被问及他们的手术量、PLND 的适应证、根据解剖图谱划分的哪些淋巴结包被解剖以及手术入路的类型。
在 340 名成员中，有 183 名泌尿科医生（58%）完成了调查。其中，43%的人距离住院医师培训结束≥10 年，62%的人每年进行>50 例根治性前列腺切除术。在接受调查的外科医生中，45%的人对所有接受根治性前列腺切除术的患者进行 PLND。其余人则使用各种风险分层方案。报告了 32 种不同的 PLND 适应证，最常见的是根据美国泌尿外科学会的风险分类为“中危”。至于 PLND 的范围，15%的人进行仅限于髂外的 PLND，而 30%的人包括髂外、闭孔窝和腹下淋巴结。在使用开放和机器人方法的外科医生中，19%的人报告说，淋巴结切除术的适应证和范围根据所使用的手术方法而不同。
这项调查的结果提供了对泌尿外科肿瘤学家关于 PLND 的实践模式的深入了解，并强调了在确定何时以及如何进行 PLND 方面缺乏一致性。需要共同努力制定关于这一问题的指南，这是标准化手术临床试验结果报告的必要步骤。
