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01-06-2016 | Original Article

Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effect on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis

Authors: Georgios Hatzichristodoulou, Stefan Wagenpfeil, Gudrun Wagenpfeil, Tobias Maurer, Thomas Horn, Kathleen Herkommer, Marie Hegemann, Jürgen E. Gschwend, Hubert Kübler

Published in: World Journal of Urology | Issue 6/2016

Abstract

Purpose

To assess continence and erectile function (EF) recovery of extended pelvic lymph node dissection (ePLND) versus limited PLND (lPLND) after bilateral nerve-sparing radical prostatectomy (BNSRP).

Methods

Consecutive prostate cancer (PCa) patients undergoing BNSRP were stratified according to D’Amico into two groups: low-risk-PCa lPLND (obturator) and intermediate-/high-risk-PCa ePLND (obturator, external iliac artery, internal iliac artery, common iliac artery). Continence (no pad/one safety pad) and EF (IIEF-5 ≥ 17) recovery were assessed. Patients with phosphodiesterase type 5 inhibitors, neoadjuvant/adjuvant therapy, positive lymph nodes or positive surgical margins were excluded.

Results

From January 2007 to May 2012, a total 966 consecutive patients were included. Four hundred and sixty patients met the inclusion/exclusion criteria: 262 patients had ePLND and 198 patients had lPLND. Mean number of lymph nodes was 20.4 (range 10–65) and 4.7 (range 0–10), respectively (p < 0.001). Continence and spontaneous EF recovery after 12 months were 89.7 versus 93.4 % and 40.4 versus 47.5 %, respectively (all p > 0.05). Patient age at surgery (p = 0.001), preoperative EF (p < 0.001) and pathological tumor stage (p = 0.008), but not ePLND (p = 0.561), were independent predictors of EF recovery. No association was detected for continence recovery. Seven-year BCR-free survival for pT2 PCa was 100 and 94.8 % in lPLND and ePLND, respectively (p = 0.011). For pT3 PCa, this was 94.7 and 81.2 %, respectively (p = 0.287). At 2 years, the trifecta of continence, potency and recurrence freedom was achieved in 47.5 and 44.1 % in lPLND and ePLND, respectively (p = 0.451).

Conclusions

ePLND is not associated with increased risk of postoperative incontinence or erectile dysfunction. Only patient age at surgery, preoperative EF and pathological tumor stage represent predictors of EF recovery.

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Title: Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effect on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis
Authors: Georgios Hatzichristodoulou
Stefan Wagenpfeil
Gudrun Wagenpfeil
Tobias Maurer
Thomas Horn
Kathleen Herkommer
Marie Hegemann
Jürgen E. Gschwend
Hubert Kübler
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 6/2016
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1699-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effect on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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