EXTENDED PELVIC LYMPH NODE DISSECTION DOES NOT AFFECT URINARY CONTINENCE RECOVERY IN PATIENTS AFFECTED BY PROSTATE CANCER TREATED WITH NERVE SPARING RADICAL PROSTATECTOMY
Ettore Di Trapani, Giorgio Gandaglia, Paolo Dell'Oglio, Niccolò Maria Passoni, Nicola Fossati, Alessandro Nini, Bianchi Marco, Milan, Italy, Rocco Damiano, Francesco Cantiello, Catanzaro, Italy, Giuseppe Zanni, Marco Moschini, Andrea Salonia, Giorgio Guazzoni, Francesco Montorsi, Alberto Briganti, Milan, Italy
INTRODUCTION AND OBJECTIVES: Extended pelvic lymph node dissection (ePLND) might be associated with damages to the pelvic plexus, potentially affecting erectile function (EF) and urinary continence (UC) recovery after radical prostatectomy (RP). While previous studies reported that ePLND does not affect EF recovery in patients treated by bilateral nerve sparing RP (BNSRP), evidence is scarce regarding the impact of ePLND on UC recovery.
METHODS: The study included 348 low/intermediate risk patients with prostate cancer (PCa) treated with NSRP at a single referral tertiary center between December 2006 and June 2011. All patients had complete preoperative data available. Patients were retrospectively divided into two groups based on PLND status: no PLND (n=109, 31.3%) and ePLND (n=239, 68.7%) at the time of surgery. Decision to perform ePLND was left to the clinical judgment of the treating physician. All patients had preoperative functional and oncological data. UC recovery was defined as being completely pad free over a 24 hours period. Univariable and multivariable Cox regression models tested the association between ePLND and UC recovery after surgery, after accounting for confounders (i.e., age at surgery, BMI, preoperative International Index of Erectile Function and risk group according to D’Amico risk group classification).
RESULTS: At a mean follow up of 37.8 months (median: 37) 243 patients (69.8%) recovered UC. Overall, postoperative UC recovery rate at 1 and 2 years were 67.5% and 69.6%, respectively. No significant differences were recorded when patients were stratified according to the extent of PLND (UC recovery rate at 2-yr follow up: 76.4% vs67.2% in patients not undergoing PLND vs patients receiving ePLND; p=0.11). These results were confirmed at multivariable analyses, where ePLND did not represent an independent predictor of UC recovery(p=0.29).Conversely, age at surgery was the only multivariable predictor of post-operative UC recovery (p=0.04). Patients younger than 60 years had 2.3-fold higher probability to recover UC after surgery as compared to those older than 70 years (p=0.04) after accounting for confounders.
DISCUSSION:When indicated, ePLND can be safely performed without compromising urinary outcomes.
CONCLUSIONS: The extent of PLND is not associated with UC recovery after BNSRP.