Multicenter evaluation of guideline adherence for pelvic lymph node dissection in patients undergoing open retropubic vs. laparoscopic or robot assisted radical prostatectomy according to the recent German S3 guideline on prostate cancer

  • Angelika Borkowetz
  • Johannes Bruendl
  • Martin Drerup
  • Jonas Herrmann
  • Hendrik Isbarn
  • Burkhard Beyer
  • On behalf of the GeSRU Academics Prostate Cancer Group
Original Article

Abstract

Purpose

Pelvic lymph node dissection (PLND) is recommended for patients with prostate cancer (PCa) and significant risk for nodal metastases. This study aimed to assess guideline adherence regarding PLND according to the German S3 guideline as example for a national but highly used guideline on prostate cancer and to compare the rate of complications different approaches for radical prostatectomy (RP).

Methods

Patients undergoing open (RRP), laparoscopic (LARP) or robot-assisted (RARP) RP in six centers in Germany and Austria were included. The primary endpoint was the total number of removed lymph nodes (LN) between the different surgical approaches according to recent guideline recommendations. Secondary endpoints were the number of patients undergoing a sufficient PLND, defined as a removal of at least 10 LN and associated complication rates.

Results

2634 patients undergoing RP were included (RRP: 66%, RARP/LARP: 34%). PLND was performed in 88% (RRP: 88.5%, RARP/LARP: 86.8%, p = 0.208). In intermediateor high risk PCa, PLND was performed in 97.2% (RRP: 97.7%, RARP/LARP: 96.2, p = 0.048). Of those, the mean number of LN was 19 (RRP: 19 vs. RARP/LARP: 17, p < 0.005) and sufficient PLND was observed in 84.6% of RRP compared to 77.2% of RARP/LARP (p < 0.005). Symptomatic lymphoceles requiring surgical treatment occurred more often in RRP than in RARP/LARP (4.0% vs. 1.6%, p = 0.001).

Conclusions

The general guideline adherence regarding performing PNLD and the LN yield is high, regardless of the surgical approach. As expected, lymph node yield was higher when very experienced surgeons conducted the procedure. This should be considered in patients’ counseling.

Keywords

Pelvic lymph node dissection Guidelines Adherence Prostate cancer Prostatectomy 

Abbreviations

LN

Lymph node

PLND

Pelvic lymph node dissection

PCa

Prostate cancer

LARP

Laparoscopic radical prostatectomy

RARP

Robot-assisted radical prostatectomy

RRP

Retropubic radical prostatectomy

IQR

Interquartile range

Notes

Author contributions

AB Project development, Data collection and management, Data analysis, Manuscript writing; JB Project development, Data collection; MD Project development, Data collection; JH Project development, Data collection; HI Project development, Data collection, supervision; BB Project development, Data collection, Manuscript writing.

Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable standards. For this type of study formal consent is not required. This article does not contain any studies with or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Angelika Borkowetz
    • 1
  • Johannes Bruendl
    • 2
  • Martin Drerup
    • 3
  • Jonas Herrmann
    • 4
  • Hendrik Isbarn
    • 5
    • 6
  • Burkhard Beyer
    • 6
  • On behalf of the GeSRU Academics Prostate Cancer Group
  1. 1.Department of UrologyUniversity Hospital Carl Gustav Carus, Technische Universität DresdenDresdenGermany
  2. 2.Department of Urology, Caritas St. Josef Medical CenterUniversity RegensburgRegensburgGermany
  3. 3.Department of UrologyUniversity Hospital SalzburgSalzburgAustria
  4. 4.Department of UrologyTheresien Hospital MannheimMannheimGermany
  5. 5.Department of UrologyRegio Clinic ElmshornElmshornGermany
  6. 6.Martini-Klinik, Prostate Cancer Center HamburgHamburgGermany

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