Prostat Kanseri Hastalarında Pelvik Lenf Nodu Diseksiyonu

Yıl 2016, Cilt: 8 Sayı: 1, 47 - 51, 01.03.2016

Fazlı Polat Süleyman Yeşil Ali Atan

Öz

Prostat kanseri PKa tanısı konulan kişilerin önemli bir kısmı radikal prostatektomi RP olmayı tercih ederler. Ancak RP ile beraber pelvik lenf nod diseksiyonu PLND yapılması en tartışmalı konulardan birisidir. Çünkü prostat kanseri olan olguların tamamında lenf nodu tutulumu yoktur, dikkatli bir PLND zaman alıcı bir işlemdir ve deneyimli bir ürolog tarafından yapılmalıdır. Uygun kişilerde RP ile beraber PLND yapılması hem doğru evreleme hem de kür sağlanması açısından çok önemlidir. Bu nedenle doğru hastalarda RP ile beraber PLND yapılması gereklidir. Klinik bulgulara, radyolojik görüntüleme yöntemlerine ve nomogramlara dayalı olarak PLND yapma kararı verilir. Bu derlemede PLND’nun sınırları, faydası ve komplikasyonları anlatılmaktadır

Anahtar Kelimeler

Prostat kanseri, pelvik lenfadenektomi

Pelvic Lymph Node Dissection In Patients With Prostate Cancer

Öz

Important part of the patients with prostate cancer prefer undergoing radical prostatectomy RP . However, pelvic lymph node dissection PLND along with RP is one of the most controversial issue. Because lymph nod involvement is not available in all cases with PKa, PLND is a time-consuming procedure and PLND must be perfomed by an experienced urologist. RP along with PLND in relevant cases is very important to obtain both correct staging and cure. Therefore, RP along with PLND is required in correct patients. According to clinical findings, radiologic imaging methods and nomograms, decision of PLND is made. Borders, benefits and complications of PLND in this review is explained

Anahtar Kelimeler

Prostate cancer, pelvic lymphadenectomy

Kaynakça

• Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Can- cer J. 2014; 64: 9–29
• Y. Fradet, L. Klotz, J. Trachtenberg, and A. Zlotta. The burden of prostate cancer in Canada. J Can Urol Assoc. 2009; 3 (supplement 2): 102–108
• Kotb AF, Elabbady AA. Prognostic factors for the development of biochemical recurrence after radical prostatectomy. Prostate Cancer. 2011;2011:485189. doi: 10.1155/2011/485189. Epub 2011 Jun 15.
• Simmons MN, Stephenson AJ, Klein EA. Natural history of bioc- hemical recurrence after radical prostatectomy: risk assessment for secondary therapy. Eur Urol. 2007; 51: 1175-1184
• Cooperberg MR, Broering JM, Litwin MS, Lubeck DP, Mehta SS, Henning JM, et al. The contemporary management of prostate can- cer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disea- se registry. J Urol. 2004;171: 1393-401
• Fowler JE Jr, Whitmore WF Jr. The incidence and extent of pelvic lymph node metastases in apparently localized prostatic cancer. Cancer. 1981; 47: 2941-5
• Zincke H. Extended experience with surgical treatment of stage D1 adenocarcinoma of prostate. Significant influences of immedi- ate adjuvant hormonal treatment (orchiectomy) on outcome. Uro- logy. 1989; 33 (5 Suppl): 27-36
• Petros JA, Catalona WJ. Lower incidence of unsuspected lymph node metastases in 521 consecutive patients with clinically locali- zed prostate cancer. J Urol. 1992; 147: 1574-5
• Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am. 2001; 28: 555-65
• Kawakami J, Meng MV, Sadetsky N, Latini DM, Duchane J, Carroll PR; CaPSURE Investigators. Changing patterns of pelvic lymphadenectomy for prostate cancer: results from CaPSURE. J Urol. 2006;176 (4 pt 1): 1382-1386
• Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR, Montorsi F, Studer UE. Pelvic lymph node dissection in prostate cancer. Eur Urol. 2009; 55:1251-65
• D'Amico AV, Schnall M, Whittington R, Malkowicz SB, Schultz D, Tomaszewski JE, Wein A.. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radi- ation therapy for clinically localized prostate cancer. JAMA. 1998; 280: 969-974
• Boorjian SA, Karnes RJ, Rangel LJ, Bergstralh EJ, Blute ML. Mayo Clinic validation of the D’Amico risk group classification for predicting survival following radical prostatectomy. J Urol. 2008;179:1354-1360
• Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and down- grading of prostate cancer from biopsy to radical prostatectomy: in- cidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol. 2012; 61:1019–24
• Gakis G, Boorjian SA, Briganti A, Joniau S, Karazanashvili G, Karnes RJ, Mattei A, Shariat SF, Stenzl A, Wirth M, Stief CG. The role of radical prostatectomy and lymph node dissection in lymph node-positive prostate cancer: a systematic review of the literature. Eur Urol. 2014; 66: 191–199
• Joung JY, Cho IC, Lee KH. Role of pelvic lymph node dissection in prostate cancer treatment. Korean J Urol. 2011; 52: 437-445
• Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, Bianchi M, Sun M, Freschi M, Salonia A, Karakiewicz PI, Ri- gatti P, Montorsi F. Updated Nomogram Predicting Lymph Node Invasion in Patients with Prostate Cancer Undergoing Extended Pelvic Lymph Node Dissection: The Essential Importance of Per- centage of Positive Cores. Eur Urol. 2012; 61: 480-7
• Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M, Epstein JI, Walsh PC, Trock BJ, Partin AW. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int. 111: 22-9, 2013
• Loeb S, Partin AW, Schaeffer EM. Complications of pelvic lymphadenectomy: do the risks outweigh the benefits? Rev Urol. 2010; 12: 20-24
• Dobruch J, Piotrowicz S, Skrzypczyk M, Gołąbek T, Chłosta P, Borówka A. Clinical value of extended pelvic lymph node dissec- tion in patients subjected to radical prostatectomy. Videosurgery Miniinv. 2014; 9: 64–70
• Joniau S, Van den Bergh L, Lerut E, Deroose CM, Haustermans K, Oyen R, Budiharto T, Ameye F, Bogaerts K, Van Poppel H. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol. 2013; 63: 450-8
• Bader P, Burkhard FC, Markwalder R, Studer UE. Is a limited lymph node dissection an adequate staging procedure for prostate cancer? J Urol. 2002;168:514–8
• Weckermann D, Dorn R, Trefz M, Wagner T, Wawroschek F, Harz- mann R. Sentinel lymph node dissection for prostate cancer: expe- rience with more than 1,000 patients. J Urol. 2007;177:916–20
• Heck MM, Retz M, Bandur M, Souchay M, Vitzthum E, Weirich G, Mollenhauer M, Schuster T, Autenrieth M, Kübler H, Maurer T, Thalgott M, Herkommer K, Gschwend JE, Nawroth R.Topography of lymph node metastases in prostate cancer patients undergoing radical prostatectomy and extended lymphadenectomy: results of a combined molecular and histopathologic mapping study. Eur Urol. 2014; 66: 222 –229
• Mattei A, Fuechsel FG, Bhatta Dhar N, Warncke SH, Thalmann GN, Krause T, Studer UE. The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multi- modality mapping study. Eur Urol. 2008; 53: 118–25
• Kim KH, Lim SK, Koo KC, Han WK, Hong SJ, Rha KH. Exten- ded lymph node dissection in robot-assisted radical prostatectomy: lymph node yield and distribution of metastases. Asian J Androl. 2014; 16: 824–828
• Yuh B, Artibani W, Heidenreich A, Kimm S, Menon M, Novara G, Tewari A, Touijer K, Wilson T, Zorn KC, Eggener SE.The role of robot-assisted radical prostatectomy and pelvic lymph node dis- section in the management of high-risk prostate cancer: a systema- tic review. Eur Urol. 65: 918-927, 2014
• Heidenreich A, Varga Z, von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol. 2002;167:1681–6
• Clark T, Parekh DJ, Cookson MS, Chang SS, Smith ER Jr, Wells N, Smith J Jr. Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol. 2003; 169:145-7
• Bivalacqua TJ, Pierorazio PM, Gorin MA, Allaf ME, Carter HB, Walsh PC.Anatomic extent of pelvic lymph node dissection: impact on long-term cancer-specific outcomes in men with positive lymph nodes at time of radical prostatectomy. Urol. 2013; 82: 653–659
• Briganti A, Chun FK, Salonia A, Zanni G, Gallina A, Dehò F, Su- ardi N, Da Pozzo LF, Valiquette L, Rigatti P, Montorsi F, Kara- kiewicz PI.. A nomogram for staging of exclusive nonobturator lymph node metastases in men with localized prostate cancer. Eur Urol. 2007; 51:112–19
• Golimbu M, Morales P, Al-Askari S, Brown J. Extended pelvic lymphadenectomy for prostatic cancer. J Urol. 1979; 121: 617-20
• Pagliarulo V, Hawes D, Brands FH, Groshen S, Cai J, Stein JP, Lieskovsky G, Skinner DG, Cote RJ. Detection of occult lymph node metastases in locally advanced node-negative prostate can- cer. J Clin Oncol. 2006; 24:2735–42
• Ji J, Yuan H, Wang L, Hou J. Is the impact of the extent of lympha- denectomy in radical prostatectomy related to the disease risk? A single center prospective study. J Surg Res. 2012;178: 779–84
• Weingartner K, Ramaswamy A, Bittinger A, Gerharz EW, V¨oge D, and Riedmiller H. Anatomical basis for pelvic lymphadenec- tomy in prostate cancer: results of an autopsy study and implicati- ons for the clinic. J Urol. 1996; 156: 1969–1971
• Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, Sha- riat SF, Perrotte P, Montorsi F, Karakiewicz PI. Lymph node count threshold for optimal pelvic lymph node staging in prostate cancer. Int J Urol. 2012;19: 645–51
• Chodak GW, Thisted RA, Gerber GS, Johansson JE, Adolfsson J, Jo- nes GW, Chisholm GD, Moskovitz B, Livne PM, Warner J. Results of radical prostatectomy in men with locally advanced prostate cancer: multiinstitutional pooled analysis. Eur Urol. 1997; 32: 385–90
• Cheng L, Zincke H, Blute ML, Bergstralh EJ, Scherer B, Bostwick DG. Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer. 2001; 91:66–73
• Briganti A, Karnes JR, Da Pozzo LF, Cozzarini C, Gallina A, Suardi N, Bianchi M, Freschi M, Doglioni C, Fazio F, Rigatti P, Montorsi F, Blute ML. Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node po- sitive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N+ patients treated with radical prostatectomy, extended pelvic lymph node dissection and adju- vant therapy. Eur Urol. 2009; 55: 261–70
• Daneshmand S, Quek ML, Stein JP, Lieskovsky G, Cai J, Pinski J, Skinner EC, Skinner DG. Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long- term results. J Urol. 2004; 172: 2252-5
• Engel J, Bastian PJ, Baur H, Beer V, Chaussy C, Gschwend JE, Oberneder R, Rothenberger KH, Stief CG, Hölzel D. Survival be- nefit of radical prostatectomy in lymph node-positive patients with prostate cancer. Eur Urol. 2010; 57: 754–61
• Ghavamian R, Bergstralh EJ, Blute ML, Slezak J, Zincke H. Radi- cal retropubic prostatectomy plus orchiectomy versus orchiectomy alone for pTxN+ prostate cancer: a matched comparison. J Urol. 1999;161:1223–7
• Joniau S, Hsu CY, Gontero P, Spahn M, Van Poppel H. Radical prosta- tectomy in very high-risk localized prostate cancer: long-term outco- mes and outcome predictors. Scand J Urol Nephrol. 2012; 46:164-71
• Johnstone PA, Ward KC, Goodman M, Assikis V, Petros JA. Radical prostatectomy for clinical T4 prostate cancer. Cancer. 2006; 106: 2603-9
• Moltzahn F, Karnes J, Gontero P, Kneitz B, Tombal B, Bader P, Bri- ganti A, Montorsi F, Van Poppel H, Joniau S, Spahn M. Predicting prostate cancer-specific outcome after radical prostatectomy among men with very high-risk cT3b/4 PCa: a multi-institutional outcome study of 266 patients. Prostate Cancer Prostatic Dis. 2015; 18: 31-7
• Yossepowitch O, Eggener SE, Serio AM, Carver BS, Bianco FJ Jr, Scardino PT, Eastham JA. Secondary therapy, metastatic progression, and cancer-specific mortality in men with clinically high-risk prostate cancer treated with radical prostatectomy. Eur Urol. 2008;53:950–9
• Heesakkers RA, Hövels AM, Jager GJ, van den Bosch HC, Witjes JA, Raat HP, Severens JL, Adang EM, van der Kaa CH, Fütterer JJ, Barentsz J. Cost-analysis of staging methods for lymph nodes in patients with prostate cancer: MRI with a lymph node-specific contrast agent compared to pelvic lymph node dissection or CT. Eur Radiol. 2004;14:1707-1712
• Campbell SC, Klein EA, Levin HS, Piedmonte MR. Open pelvic lymph node dissection for prostate cancer: a reassessment. Uro- logy. 1995; 46:352-355
• Sogani PC, Watson RC, Whitmore WF Jr. Lymphocele after pelvic lymphadenectomy for urologic cancer. Urology. 1981;17:39-43
• Abou-Elela A, Reyad I, Torky M, Meshref A, Morsi A. Laparos- copic marsupialization of postrenal transplantation lymphoceles. J Endourol. 2006; 20:904-909
• Raboy A, Adler H, Albert P. Extraperitoneal endoscopic pelvic lymph node dissection: a review of 125 patients. J Urol. 1997; 158: 2202-2204
• Sorumlu Yazar: Prof. Dr. Ali Atan
• Birlik Mahallesi, 396 sokak, 14/11 Çankaya-Ankara
• e-mail: [e-mail] Tel: [phone]