Cacciamani Giovanni E, Porcaro Antonio B, Sebben Marco, Tafuri Alessandro, Rizzetto Riccardo, De Luyk Nicolò, Ciocchetta Elisa, Processali Tania, Pirozzi Marco, Amigoni Nelia, Corsi Paolo, Brunelli Matteo, De Marco Vincenzo, Artibani Walter
Department of Urology, University of Verona, Verona, Italy -
Department of Urology, University of Verona, Verona, Italy.
Minerva Urol Nefrol. 2019 Apr;71(2):136-145. doi: 10.23736/S0393-2249.19.03342-3. Epub 2019 Feb 14.
The aim of this study was to assess the anatomical prevalence and secondary involvement of Cloquet's nodes in patients undergoing robotic radical prostatectomy (RRP) and extended pelvic lymph node dissection (ePLND) for prostate cancer (PCa).
RRP and ePLND were performed by two expert surgeons (WA and VDM). Data were prospectively collected and retrospectively analyzed. Dissected pelvic lymph nodes were sampled according to an anatomical template as follows: external iliac, obturator, Marcille's, and Cloquet's. Node packages were sent to the dedicated pathologist separately. Baseline characteristics, perioperative and pathological outcomes were analyzed.
Between January 2014 and December 2017 a total of 258 patients were evaluated. In aggregate 247 out of 258 patients (95.7%) presented at least a lymph node in the in the Cloquet's fossa tissue and 105 (40.6%) had more than one node. Patients with multiple nodes in Cloquet fossa presented higher median lymph node amount (27 vs. 33; P<0.0001). 13.5% of patients had lymph node invasion Pathological evaluation of the Cloquet's nodes showed metastatic PCa in 3 out of 35 (8.6%) pN+ patients. No differences were found when patients with metastatic Cloquet's nodes were compared with the pN+ population in terms of demographics, PSA, D'Amico classification, biopsy and pathological Gleason Grouping, clinical and pathological stage and complications.
To the best of our knowledge this is the first study that analyses specifically the quantitative prevalence of Cloquet's nodes and the incidence of malignancy involvement in patients undergoing RRP and ePLND for PCa. The occurrence of multiple lymph nodes in the Cloquet fossa is a rare event. Our series showed that Cloquet involvement seems to be associated with multiple nodes cohabitation and contemporarily multiple lymph node metastases in other template locations. Related morbidity rate is sporadic and cannot justify the Cloquet preservation. Wider series are required to comprehend predictor factors of Cloquet nodes involvement. Until then the Cloquet lymphadenectomy would be recommended and should not be an option.
本研究的目的是评估接受机器人根治性前列腺切除术（RRP）和扩大盆腔淋巴结清扫术（ePLND）治疗前列腺癌（PCa）患者中克洛凯淋巴结的解剖学患病率及继发性受累情况。
RRP和ePLND由两位专家外科医生（WA和VDM）实施。数据进行前瞻性收集和回顾性分析。按照如下解剖模板对切除的盆腔淋巴结进行采样：髂外、闭孔、马尔西耶及克洛凯淋巴结。淋巴结包分别送交专门的病理学家。分析基线特征、围手术期及病理结果。
2014年1月至2017年12月期间共评估了258例患者。总计258例患者中有247例（95.7%）在克洛凯窝组织中至少有一个淋巴结，105例（40.6%）有多个淋巴结。克洛凯窝有多个淋巴结的患者中位淋巴结数量更多（27个对33个；P<0.0001）。13.5%的患者有淋巴结转移。对克洛凯淋巴结的病理评估显示，35例pN+患者中有3例（8.6%）存在转移性PCa。在人口统计学、前列腺特异性抗原（PSA）、达米科分类、活检及病理格里森分级、临床及病理分期和并发症方面，将有转移性克洛凯淋巴结的患者与pN+人群进行比较时未发现差异。
据我们所知，这是第一项专门分析接受RRP和ePLND治疗PCa患者中克洛凯淋巴结的定量患病率及恶性肿瘤受累发生率的研究。克洛凯窝出现多个淋巴结是罕见事件。我们的系列研究表明，克洛凯淋巴结受累似乎与多个淋巴结共存以及同时在其他模板位置出现多个淋巴结转移有关。相关发病率是偶发的，不能成为保留克洛凯淋巴结的理由。需要更广泛的系列研究来了解克洛凯淋巴结受累的预测因素。在此之前，建议进行克洛凯淋巴结清扫术，不应选择保留。
