Sentinel node biopsy in combination with extended pelvic lymph node dissection for men with prostate cancer at

Transl Cancer Res 2016;5(Suppl 7):S1377-S1379 tcr.amegroups. com Initial diffusion of prostate cancer (PCa) occurs in the regional lymph node (LN) stations. Positive LNs represent a significant adverse prognostic factor in PCa and can be associated with systemic metastases (1,2). Several anatomic studies with extensive lymphadenectomy have demonstrated that the obturator fossa is not always the primary site for LNs metastasis: therefore, pelvic LN dissection (LND) limited to the obturator fossa can miss about 50% of LN metastases. Therefore, an extended pelvic LN dissection (ePLND) should be performed in all intermediate-high-risk PCa, while a limited LND should be avoided, for the high risk of missing at least half the nodes involved (3). An ePLND provides several prognostic data, including the number of positive LNs, the volume of metastasis within the LN and the penetration of the capsule of the node, which cannot be achieved with other techniques. ePLND for PCa should include not only the external and obturator regions as well as the portions medial and lateral to the internal iliac vessels, but also the common iliac LNs at least up to the ureteric crossing, thus removing approximately 75% of all nodes potentially harboring metastasis (4). The assessment of an extended lymphadenectomy is performed in relation to the template and the number of LNs removed (5). The ePLND needs of surgical skills and is time consuming. The benefits of ePLND are accompanied by the potential intraoperative and postoperative complications. Intraoperative complications inherent to ePLND include ureteral, major vascular, and obturator nerve (sensory or motor neuropraxia) injury. Postoperative complications include symptomatic pelvic lymphocele, development of lymphoedema, ileus, deep venous thrombosis, and pulmonary embolism. The most common complication is the pelvic lymphocele. It is frequently asymptomatic and usually remains undetected. However, in some cases it is necessary to place drainage, in particular for compression phenomena on the vessels or for infections (6). With the development of minimally invasive surgery, a simple sentinel LN biopsy (SNB) has been proposed as a novel promising technique to reduce the risk of complication, improve the staging efficacy and limit operative time. The sentinel LN is the first node that receives lymphatic drainage from the primary tumor: the concept of the SNB is based on the observation that metastases do not occur in downstream nodes if sentinel LNs are free of tumors. Sentinel guided lymphadenectomy has replaced extended lymphadenectomy in several neoplasms: in particular, for tumor such as breast cancer, penile cancer, and melanoma, SNB has become routine for nodal staging. In 1999, Wawroschek et al. (7) started to transfer techniques and concepts of sentinel node identification to PCa. technetium nanocolloid was transrectally injected directly into the two lobe of the prostate under ultrasound guidance 1 day before pelvic lymphadenectomy. Thereafter a dynamic lymphoscintigraphy and an intraoperative identification with a gamma probe were done. Lymphatic drainage for the prostate gland is highly variable and Editorial