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Pelvic Lymph Node Dissection for Prostate Cancer

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Abstract

Pelvic lymph node dissection (PLND) is a critical element of an oncologically well-performed radical prostatectomy. PLND provides critical staging information that may be used to influence or guide treatment. Mounting evidence also demonstrates that PLND likely has an important therapeutic role. Unfortunately, especially in the current era of minimally invasive surgery, PLND is often performed poorly, if at all, and data regarding PLND are often omitted from published reports. The cause for the apparent decline in the recognition of the importance of a PLND is not entirely clear but appears to inversely mirror the increase in the prevalence of robotic prostatectomy. The lack of a complete PLND in many robotic cases may be partially due to uncertainty that a thorough PLND can be performed robotically and result in outcomes equivalent to a thorough open lymphadenectomy. This chapter details the exact surgical steps necessary to accomplish this goal. We also review the data supporting both the diagnostic and therapeutic importance of the PLND.

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Abbreviations

CT:

Computerized tomography

EAU:

European Association of Urology

MRI:

Magnetic resonance imaging

PLND:

Pelvic lymph node dissection

PSA:

Prostate-specific antigen

ROC:

Receiver operating characteristic

RP:

Radical prostatectomy

SPECT/CT:

Single-photon emission CT

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Authors and Affiliations

  1. Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Jonathan L. Silberstein M.D.

  2. Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY, 10065, USA

    Vincent P. Laudone M.D.

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  1. Jonathan L. Silberstein M.D.
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  2. Vincent P. Laudone M.D.
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Correspondence to Vincent P. Laudone M.D. .

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Editors and Affiliations

  1. Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    James A. Eastham

  2. Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

    Edward M. Schaeffer

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Silberstein, J.L., Laudone, V.P. (2014). Pelvic Lymph Node Dissection for Prostate Cancer. In: Eastham, J., Schaeffer, E. (eds) Radical Prostatectomy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8693-0_4

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