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Radical prostatectomy and pelvic lymph node dissection for organ-confined prostate cancer. Preoperative planning, surgical technique and outcomes

Defense Thèse de privat-docent : Univ. Genève, 2013
Abstract Prostate cancer (PCa) is worldwide the second most common cancer and the sixth leading cause of cancer mortality among men. Its increasing diagnosis at the localized stage and the improved effectiveness of treatments has led to increased survival. Current treatment modalities for localized PCa are surgery (radical prostatectomy [RP]) or radiotherapy (external irradiation and brachytherapy). Lastly, considering early and late complications associated with these treatments and the attendant risk of mortality, the alternative regimen of active surveillance (AS) is indicated for selected low-risk patients. RP is the recommended curative procedure for patients with low and intermediate-risk localized PCa (cT1a-T2b, Gleason score ≤7 and PSA <20 ng/mL) and a life expectancy of at least 10 years (level of evidence [LE]: 1b). The first objective of RP is oncological radicality, the second preservation of urinary continence and erectile function. Preoperative assessment of PCa tumour stage (intracapsular or extraprostatic disease), grade and localisation is crucial for surgical planning. These data are useful in choosing the side (none, monolateral or bilateral) and extent (minimal, partial or full) of the nerve sparing procedure and which patients may benefit from a pelvic lymph-node dissection (PLND). In the preoperative setting, magnetic resonance imaging (MRI) is recommended for local staging of PCa. Due to the limitations of imaging techniques, PLND is currently the most accurate and reliable technique for assessing lymph node metastasis in high risk patients applying nomograms for lymph node invasion. PLND for PCa should be extended beyond the external and obturator regions and the portions medial and lateral to the internal iliac vessels to include also the common iliac lymph nodes at least up to the ureteric crossing. RP may be performed as classical open RP, laparoscopic or robot-assisted (RARP) RP. The current literature suggests that RARP is a valid technique for treatment of localised PCa, reporting similar oncologic outcomes versus other approaches with advantages in terms of perioperative complications, urinary continence and sexual function recovery rate. 3 However, its role in patients with high risk or locally advanced disease has not yet been defined. Due to limited follow-up time, data on survival and cancer-specific mortality are not available: further research with long-term outcomes are required.
Keywords Prostate cancerPelvic lymph node dissectionImagingSurgical technique
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MATTEI, Agostino. Radical prostatectomy and pelvic lymph node dissection for organ-confined prostate cancer. Preoperative planning, surgical technique and outcomes. Université de Genève. Thèse de privat-docent, 2013. doi: 10.13097/archive-ouverte/unige:27931 https://archive-ouverte.unige.ch/unige:27931

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Deposited on : 2013-05-21

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