Original Article
Pre‑prostatic tissue removed in robotic assisted lymph node dissection for prostate cancer contains lymph nodes J. Blarer1, C. Padevit1, K. Horton1, D. Pfofe2, H. John1, M. Horstmann1,3 Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland, 2Institute of Pathology, Kantonsspial Winterthur, Winterthur, Switzerland, 3Department of Urology, Jena University Hospital, Jena, Germany
1
Abstract
Objective: The on‑going discussion about extent and best template for pelvic lymph dissection (PLND) motivated us to analyse pre‑prostatic tissue (PPT) for lymph nodes and metastases. Materials and Methods: From December 2010 to August 2011 PPT was sent for histopathological evaluation during 80 robotic assisted radical prostatectomies (RARP) and one extended staging lymph node dissection. All patients had either a limited (lPLND, n = 44) or an extended lymph node dissection (ePLND, n = 36). Clinical data were retrospectively analyzed and compared to histopathological findings. Results: Lymph nodes were found in PPT in 10/80 (12.5%) patients after RARP and in the one patient after staging ePLND. Mean number of lymph nodes detected in PPT of them was 1.2 (range 1‑3). Clinically no differences were found between patients with or without lymph nodes in PPT. In the standard template of either ePLND or lPLND the average number of lymph nodes was 13 (range 2‑56). Herein metastases were found in 10 (12.5%) patients after RARP and in the patient after staging ePLND. A metastasis in PPT was only found after staging ePLND. Conclusions: Pre‑prostatic tissue might contain lymph nodes that potentially harbour metastases. In the intention to perform the most accurate staging this tissue should be considered for histopathological evaluation. Key Words: Lymph nodes, prostate cancer, robotic assisted radical prostatectomy
Address for correspondence: Dr. Med. Marcus Horstmann, Brauerstr 15, Kantonsspital Winterthur, 8404 Winterthur, Switzerland. E‑mail: [email protected] Received: 08.04.2012, Accepted: 12.06.2012
INTRODUCTION
For surgical reasons the anterior wall of the prostate is regularly freed from pre‑prostatic tissue (PPT) during radical robotic assisted prostatectomy (RARP). Its removal allows a better visualisation of the pubic bone, the puboprostatic ligaments, the endoplevic fascia and the anterior bladder neck. Neither Access this article online Quick Response Code:
Website: www.urologyannals.com
DOI: 10.4103/0974-7796.120301
Urology Annals
in open nor in robotic surgery is this tissue regularly sent for histopathological evaluation. Although extended pelvic lmyph node dissection (ePLND) is currently considered the gold standard of lymph node staging[1-3] and usually does not include peri-prostatic tissue, already Finely et al.[4] and Kothari et al.[5] reported the existence of lymph nodes in peri‑prostatic tissue. Recently Yuh et al.[6] evaluated – overlapping to our study period- peri‑prostatic fat for the presence of regional lymph nodes in 120 RARPs. In the present study this tissue was similarly evaluated with however, some differences in the surgical approach of PLND and time of tissue removal. MATERIALS AND METHODS
From December 2010 to August 2011 80 patients underwent RARP and one patient staging ePLND for prostate cancer at
| Oct - Dec 2013 | Vol 5 | Issue 4 259
Blarer, et al.: Lymph nodes in pre‑prostatic tissue
our institution. In all patients PPT was removed and routinely sent for histopathological evaluation after PLND. PLND consisted either of a lPLND or an ePLND. Mean age of all patients was 63 years (range 50‑77). In 44 patients a limited lymph node dissection (lPLND) defined by the obturator fossa and in 36 patients an ePLND defined inferiorly by the obturator fossa, laterally by the external iliac artery and cranially by the common iliac trunk with visualization of the ureter were performed. lPLND was performed in tumors characterized by PSA
Pre‑prostatic tissue removed in robotic assisted lymph node dissection for prostate cancer contains lymph nodes J. Blarer1, C. Padevit1, K. Horton1, D. Pfofe2, H. John1, M. Horstmann1,3 Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland, 2Institute of Pathology, Kantonsspial Winterthur, Winterthur, Switzerland, 3Department of Urology, Jena University Hospital, Jena, Germany
1
Abstract
Objective: The on‑going discussion about extent and best template for pelvic lymph dissection (PLND) motivated us to analyse pre‑prostatic tissue (PPT) for lymph nodes and metastases. Materials and Methods: From December 2010 to August 2011 PPT was sent for histopathological evaluation during 80 robotic assisted radical prostatectomies (RARP) and one extended staging lymph node dissection. All patients had either a limited (lPLND, n = 44) or an extended lymph node dissection (ePLND, n = 36). Clinical data were retrospectively analyzed and compared to histopathological findings. Results: Lymph nodes were found in PPT in 10/80 (12.5%) patients after RARP and in the one patient after staging ePLND. Mean number of lymph nodes detected in PPT of them was 1.2 (range 1‑3). Clinically no differences were found between patients with or without lymph nodes in PPT. In the standard template of either ePLND or lPLND the average number of lymph nodes was 13 (range 2‑56). Herein metastases were found in 10 (12.5%) patients after RARP and in the patient after staging ePLND. A metastasis in PPT was only found after staging ePLND. Conclusions: Pre‑prostatic tissue might contain lymph nodes that potentially harbour metastases. In the intention to perform the most accurate staging this tissue should be considered for histopathological evaluation. Key Words: Lymph nodes, prostate cancer, robotic assisted radical prostatectomy
Address for correspondence: Dr. Med. Marcus Horstmann, Brauerstr 15, Kantonsspital Winterthur, 8404 Winterthur, Switzerland. E‑mail: [email protected] Received: 08.04.2012, Accepted: 12.06.2012
INTRODUCTION
For surgical reasons the anterior wall of the prostate is regularly freed from pre‑prostatic tissue (PPT) during radical robotic assisted prostatectomy (RARP). Its removal allows a better visualisation of the pubic bone, the puboprostatic ligaments, the endoplevic fascia and the anterior bladder neck. Neither Access this article online Quick Response Code:
Website: www.urologyannals.com
DOI: 10.4103/0974-7796.120301
Urology Annals
in open nor in robotic surgery is this tissue regularly sent for histopathological evaluation. Although extended pelvic lmyph node dissection (ePLND) is currently considered the gold standard of lymph node staging[1-3] and usually does not include peri-prostatic tissue, already Finely et al.[4] and Kothari et al.[5] reported the existence of lymph nodes in peri‑prostatic tissue. Recently Yuh et al.[6] evaluated – overlapping to our study period- peri‑prostatic fat for the presence of regional lymph nodes in 120 RARPs. In the present study this tissue was similarly evaluated with however, some differences in the surgical approach of PLND and time of tissue removal. MATERIALS AND METHODS
From December 2010 to August 2011 80 patients underwent RARP and one patient staging ePLND for prostate cancer at
| Oct - Dec 2013 | Vol 5 | Issue 4 259
Blarer, et al.: Lymph nodes in pre‑prostatic tissue
our institution. In all patients PPT was removed and routinely sent for histopathological evaluation after PLND. PLND consisted either of a lPLND or an ePLND. Mean age of all patients was 63 years (range 50‑77). In 44 patients a limited lymph node dissection (lPLND) defined by the obturator fossa and in 36 patients an ePLND defined inferiorly by the obturator fossa, laterally by the external iliac artery and cranially by the common iliac trunk with visualization of the ureter were performed. lPLND was performed in tumors characterized by PSA
