Comparison of functional outcome after extended versus super-extended pelvic lymph node dissection during radical prostatectomy in high-risk localized prostate cancer

Abstract

<p>Background: Urinary continence and erectile function (EF) are best preserved when<br />meticulous dissection of prostate and nerve sparing technique are used during radical<br />prostatectomy (RP). However, extent of lymph node dissection (LND) may also adversely<br />affect functional results.<br />Objective: To determine whether performing a super-extended LND (seLND) has a<br />significant effect on recovery of urinary continence and EF after RP.<br />Design, setting, and participants: All patients who underwent RP from January 2007<br />until December 2013 were handed questionnaires assessing continence and EF. All<br />patients in whom at least an extended LND (eLND) was performed were selected. This<br />search yielded 526 patients. 172 of these patients had filed out 2 or more questionnaires<br />and were included in our analysis.<br />Outcome measurements and statistical analysis: All questionnaires were reviewed.<br />We used Kaplan–Meier analyses and multivariate Cox analysis to assess the difference<br />in recovery of continence and EF over time for eLND/seLND. Primary endpoints were full<br />recovery of continence (no loss of urine) and full recovery of EF (successful intercourse<br />possible). Patients who did not reach the endpoint when the last questionnaire was filled<br />out were censored at that time. Median follow-up was 12.43 months for continence, and<br />18.97 months for EF.<br />results and limitations: Patients undergoing seLND have a lower chance of regaining<br />both urinary continence [hazard ratio (HR) 0.59, 95% CI 0.39–0.90, p = 0.026] and EF<br />(HR 0.28, 95% CI 0.13–0.57, p = 0.009). Age at surgery had a significant influence on<br />both continence and EF in multivariate analysis. Major limitation of the study was that no<br />formal preoperative assessment of continence and potency was done.<br />conclusion: Extending the LND template beyond the eLND template may cause at<br />least a significant delay in recovery of urinary continence and leads to less recovery of EF.<br /></p>