eMedicine Specialties > Urology > Surgery

Lymph Node Dissection, Pelvic: Follow-up

Author: Frank Papanikolaou, MD, Clinical Fellow, The Hospital for Sick Children, Department of Surgery, Division of Urology, University of Toronto, Canada
Contributor Information and Disclosures

Updated: Jun 13, 2008

Outcome and Prognosis

Patients with bladder cancer only occasionally benefit from pelvic lymph node dissection (PLND). Approximately 20% of patients present with lymph node metastases at the time of cystectomy. This percentage is higher in selected populations considered to be high grade and stage. Approximately 50% of these patients have limited regional metastases (1 or 2 nodes below the iliac bifurcations) and are theoretically amenable to cure. Of the latter patients, 10-35% are cured with cystectomy and PLND alone.

The management of prostate cancer accompanied with lymph node metastases after permanent histologic evaluation is controversial. The debate is centered on whether to institute hormonal therapy immediately or upon prostate-specific antigen progression.4 Four prospective randomized trials have supported a survival benefit of early androgen ablation in locally advanced disease.5 The Messing et al (1999) study demonstrated a 25% overall survival benefit at 8 years in men with node-positive prostate cancer treated with radical prostatectomy and orchidectomy/goserelin compared to radical prostatectomy alone. However, given that the prostate-specific antigen level is a good index of disease progression, an argument also can be made to delay treatment until the prostate-specific antigen level rises.

Future and Controversies

Ablative therapies for prostate cancer (eg, cryotherapy) and investigative treatments (eg, high-intensity focused ultrasound [HIFU]) are increasing in popularity. As such, many patients who undergo these treatment modalities do not undergo lymph node dissection for staging. Laparoscopic lymph node dissections and nodal sampling through minilaparotomy are options for these patients, especially those at high risk of node-positive disease, such as patients with a prostate-specific antigen level of more than 20 ng/mL, a Gleason grade of 8-10, or high-risk biopsy data.   

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Laurence Klotz, MD, to the development and writing of this article.



More on Lymph Node Dissection, Pelvic

Overview: Lymph Node Dissection, Pelvic
Workup: Lymph Node Dissection, Pelvic
Treatment: Lymph Node Dissection, Pelvic
Follow-up: Lymph Node Dissection, Pelvic
References
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References

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Further Reading

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Keywords

pelvic lymphadenectomy, lymph node dissection, pelvic lymph node dissection, PLND, bladder cancer, prostate cancer, urethral cancer, penile cancer, genitourinary cancer

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Contributor Information and Disclosures

Author

Frank Papanikolaou, MD, Clinical Fellow, The Hospital for Sick Children, Department of Surgery, Division of Urology, University of Toronto, Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Associate Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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