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The case against extended lymph-node dissection for prostate cancer

Nature Clinical Practice Urology volume 3, pages 456–457 (2006)Cite this article

In patients with stage T1 or T2 prostate cancer, pelvic lymph-node dissection (PLND) is performed as part of the radical prostatectomy (RP) procedure, to ensure exact staging. For standard PLND, all lymph nodes in the obturator fossa—the area between the obturator nerve and the external iliac vein—are removed. For extended PLND, lymph nodes along the internal iliac artery are also removed.

The mean number of nodes removed is at least doubled in extended PLND compared with standard PLND. Heidenreich et al.1 compared extended and standard PLND in two consecutive series of patients undergoing RP. A mean of 28 nodes (range 21–42) were dissected using the extended technique in 103 patients, versus 11 nodes (range 6–19) using the standard technique in 100 patients. In these two well-matched groups, 26% were found to have positive nodes during extended PLND, compared with 12% during standard PLND. Similar results have been reported using the laparoscopic approach.2 In this study, a mean of 17.8 nodes were removed during extended PLND, versus 9.3 nodes during standard PLND. The percentage of positive nodes was 23.1% in the extended group, versus 7.3% in the standard group. Studer's group published the results of extended PLND in 365 consecutive patients.3,4 The median number of nodes removed was 21 (range 6–50). Lymph nodes were positive in 24% of patients (n = 88). Of these, 19% had positive nodes exclusively along the internal iliac artery. The authors concluded that dissection along the internal iliac (hypogastric) vessels, as well as the obturator fossa, is essential for representative staging.

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  1. the Director of the Urological Clinic at the Center of Operative Medicine, University Hospital Hamburg–Eppendorf in Hamburg, Germany

    Hartwig Huland

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  1. Hartwig Huland
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Correspondence to Hartwig Huland.

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Huland, H. The case against extended lymph-node dissection for prostate cancer. Nat Rev Urol 3, 456–457 (2006). https://doi.org/10.1038/ncpuro0561

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