Extended Pelvic Lymph Node Dissection Not Linked with ED, Incontinence

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After 2 years, continence, potency, and freedom from recurrence were achieved in almost half of men who had extended pelvic lymph node dissection.

Extended pelvic lymph node dissection (ePLND) is not associated with increased risks of post-operative incontinence or erectile dysfunction (ED) after bilateral nerve-sparing radical prostatectomy (BNSRP), a new study finds.

Lead investigator Georgios Hatzichristodoulou, MD, of Technical University of Munich, University Hospital in Germany, told Renal & Urology News that “ePLND can safely be performed when oncologically indicated without compromising continence and erectile function recovery rates.” Only patient age at surgery, preoperative erectile function (EF) and pathologic tumor stage predict post-operative EF recovery, he added.

For the study, the investigators compared continence and erectile function recovery in 262 patients with ePLND for intermediate- or high-risk prostate cancer (PCa) and 198 low-risk PCa patients with limited pelvic lymph node dissection (lPLND) serving as controls. All underwent open retropubic procedures at the hospital performed by 5 experienced surgeons. During ePLND, surgeons removed an average 20.4 lymph nodes using anatomic landmarks in areas of the obturator, external iliac artery, internal iliac, and common iliac, up to the ureteric crossing. lPLND involved an average 4.7 lymph nodes in the obturator region.

To reduce confounding, patients with neoadjuvant or adjuvant therapy, positive lymph nodes, positive surgical margins, or phosphodiesterase type 5 inhibitors were excluded from the study.

A year after surgery, continence had returned to 89.7% of men in the ePLND group and 93.4% in the lPLND group, according to results published in World Journal of Urology. Erectile function recovered in 40.4% and 47.5% men, respectively.

The researchers discovered that only patient age, pre-operative erectile function, and pathologic tumor stage predicted erectile function recovery. No factors predicted the return of continence.

With regard to oncologic outcomes, recurrence-free survival for T2 disease was 100% and 94.8% for lPLND and ePLND, respectively. For T3, these rates were 94.7% vs. 81.2%.

After 2 years, continence, potency, and freedom from recurrence were achieved in 47.5% and 44.1% of patients, respectively, a non-significant difference between the groups. “These trifecta results reflect that by means of an adequate PLND in patients with intermediate- and high-risk PCa we can achieve similar oncological and functional outcomes after BNSRP compared to patients with low-risk PCa,” the investigators stated.

Using nerve-sparing techniques is important for erectile function recovery, they emphasized. Although open surgery was used, they believe results would be similar for laparoscopic or robot-assisted BNSRP.

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