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The Template Of The Primary Lymphatic Landing Sites Of The Prostate Should Be Revisited: Results Of A Multimodality Mapping Study

September 18, 2017

UroToday- Lymphadenectomy has proven to improve the outcomes of testicular and bladder cancer. It has been proposed that an extended lymph node dissection (LND) may impact patients with prostate cancer (CaP) as well. In the online version of European Urology, Dr. Mattei and associates suggest a new LND template for CaP based upon mapping studies they performed.

The study cohort was comprised of 34 patients with clinically localized CaP. Median age was 63 years. One day prior to radical prostatectomy with LND patients were injected with nanocolloid into each prostatic lobe under ultrasound guidance. One hour after injection SPECT images were obtained using a gamma camera. These images were overlain with the corresponding CT or MRI images and read by two examiners with regard to nodal localization. During surgery lymph nodes were identified by a gamma probe and removed. Next a bilateral extended LND was performed to include the internal iliac, external iliac, and obturator nodes.

Of the 317 LN's detected by SPECT/CT/MRI fusion imaging, intraoperative gamma probe found 314 (99%). Of the 314 LN's detected intraoperatively by gamma probe, 300 could be surgically resected. The remaining LN's were difficult to access surgically. Only 38% of the 317 LN seen on SPECT/CT/MRI were located in the area of the commonly performed limited pelvic LND. The majority were in the obturator fossa (n=120) the remaining sites being the internal iliac (81), presacral, pararectal (26), common iliac (50), para-aortic/paracaval (38), and inguinal (2). Only 63% were located in the region of an extended pelvic LND. The authors propose a new LND template, up to where the ureters cross the common iliac artery. This would remove 75% of the LN's that they identified as primary landing sites.

Mattei A, Fuechsel FG, Dhar NB, Warncke SH, Thalmann GN, Krause T, Studer UE

Eur Urol. ePub: August 7, 2007
Doi: 10.1016/j.eururo.2007.07.035

Reported by UroToday Contributing Editor Christopher P. Evans, M.D

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