Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
BJU Int. 2018 May;121(5):725-731. doi: 10.1111/bju.13993. Epub 2017 Sep 17.
To assess the effect of adding lymph nodes (LNs) located along the common iliac vessels and in the fossa of Marcille to the extended pelvic LN dissection (PLND) template at radical prostatectomy (RP).
A total of 485 patients underwent RP and PLND at a referral centre between 2000 and 2008 (historical cohort: classic extended PLND template) and a total of 268 patients between 2010 and 2015 (contemporary cohort: extended PLND template including LNs located along the common iliac vessels and in the fossa of Marcille). Descriptive analyses were used to compare baseline, pathological, complication and functional data between the two cohorts. A logistic regression model was used to assess the template's effect on the probability of detecting LN metastases.
Of 80 patients in the historical cohort with pN+ disease, the sole location of metastasis was the external iliac/obturator fossa in 23 (29%), and the internal iliac in 18 (23%), while 39 patients (49%) had metastases in both locations. Of 72 patients in the contemporary cohort with pN+ disease, the sole location of metastasis was the external iliac/obturator fossa in 17 patients (24%), the internal iliac in 24 patients (33%), and the common iliac in one patient (1%), while 30 patients (42%) had metastases in >1 location (including fossa of Marcille in five patients). Among all 46 patients in the contemporary cohort with ≤2 metastases, three had one or both metastases in the common iliac region or the fossa of Marcille. The adjusted probability of detecting LN metastases was higher, but not significantly so, in the contemporary cohort. There were no differences between the two cohorts in complication rates and functional outcomes.
A more extended template detects LN metastases in the common iliac region and the fossa of Marcille and is not associated with a higher risk of complications; however, the overall probability of detecting LN metastases was not significantly higher.
评估在根治性前列腺切除术（RP）中，将位于髂总血管和 Marcille 窝的淋巴结（LNs）加入扩展盆腔淋巴结清扫术（PLND）模板中对淋巴结的影响。
共有 485 名患者于 2000 年至 2008 年期间在一家转诊中心接受 RP 和 PLND（历史队列：经典扩展 PLND 模板），共有 268 名患者于 2010 年至 2015 年期间接受 RP 和 PLND（当代队列：包括位于髂总血管和 Marcille 窝的淋巴结的扩展 PLND 模板）。采用描述性分析比较了两组患者的基线、病理、并发症和功能数据。采用逻辑回归模型评估模板对检测淋巴结转移概率的影响。
在历史队列中，80 例 pN+疾病患者中，转移的唯一部位在外髂/闭孔窝 23 例（29%），在髂内 18 例（23%），而 39 例（49%）患者有两个部位的转移。在当代队列中，72 例 pN+疾病患者中，转移的唯一部位在外髂/闭孔窝 17 例（24%），在髂内 24 例（33%），在髂总 1 例（1%），而 30 例（42%）患者有一个以上部位的转移（包括 5 例 Marcille 窝）。在当代队列中，所有 46 例转移灶≤2 枚的患者中，有 3 例有一枚或两枚转移灶位于髂总血管区域或 Marcille 窝。虽然调整后检测淋巴结转移的概率更高，但差异无统计学意义。两组患者在并发症发生率和功能结局方面无差异。
更广泛的模板可检测到髂总血管区域和 Marcille 窝的淋巴结转移，且与并发症风险增加无关；然而，检测淋巴结转移的总体概率并无显著提高。
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