Colicchia Michele, Sharma Vidit, Abdollah Firas, Briganti Alberto, Jeffrey Karnes R
Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA.
Center for Outcomes Research Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
Curr Urol Rep. 2017 Jul;18(7):51. doi: 10.1007/s11934-017-0696-5.
Extent of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) remains a subject of debate. Here, we review the literature covering the value of extended PLND (ePLND) during RP for high-risk prostate cancer (PCa) over a standard PLND, with a focus on potential therapeutic advantage. PLND may provide valuable prognostic information to high-risk PCa patients, and incorporating the common iliac and presacral nodes to ePLND templates further improves pathologic nodal staging accuracy. Although increased PLND extent is associated with increased lymphocele/lymphedema rates, it is not associated with increased venous thromboembolism rates. The therapeutic role of ePLND remains uncertain. While recent retrospective studies suggest an increased number of nodes removed within the ePLND template are associated with improved survival outcomes, such retrospective studies cannot completely adjust for the Will Rodgers phenomenon or surgeon-specific factors. Thus, the results of randomized trials are eagerly awaited in this arena.
根治性前列腺切除术（RP）期间盆腔淋巴结清扫（PLND）的范围仍是一个有争议的话题。在此，我们回顾了关于RP期间扩大盆腔淋巴结清扫（ePLND）相对于标准PLND用于高危前列腺癌（PCa）的价值的文献，重点关注潜在的治疗优势。PLND可为高危PCa患者提供有价值的预后信息，将髂总淋巴结和骶前淋巴结纳入ePLND模板可进一步提高病理淋巴结分期的准确性。虽然PLND范围的增加与淋巴囊肿/淋巴水肿发生率的增加相关，但与静脉血栓栓塞发生率的增加无关。ePLND的治疗作用仍不确定。虽然最近的回顾性研究表明，ePLND模板内切除的淋巴结数量增加与生存结果改善相关，但此类回顾性研究无法完全校正威尔·罗杰斯现象或外科医生特定因素。因此，这一领域急切期待随机试验的结果。
