Pelvic lymph node dissection (PLND) is important for accurate staging and prognosis of prostate and/or bladder cancer. Several guidelines recommend extended PLND for patients with these cancers. However, the therapeutic benefits of extended PLND are unclear. One major reason is that the extent of PLND is not clearly defined. Thus, the working group for standardization of robot-assisted PLND, including nine experienced urologists for PLND in Japan, was launched in January 2023 by the Japanese Society of Endourology and Robotics. This study summarized the discussions to define the individual extent of PLND in urological surgery in a consensus meeting among these experienced urologists. The consensus meeting determined the extent of PLND based on arteries (veins) and anatomical membrane structures rather than a vague concept or approach toward PLND. This concept is expected to allow surgeons to implement the same extent of PLND. Finally, after a total of 10 online web conferences were held, we determined the extent of PLND for the obturator lymph node (LN) area, the internal iliac LN area, the external and common iliac LN area, and the presacral LN area according to the above rules. The extent of PLND suggested here currently does not have a clear therapeutic rationale. Therefore, the extent of our proposed PLND is by no means mandatory. We hope our definition of the extent of PLND will be supported by further evidence of therapeutic benefits for urologic cancers.
International journal of urology : official journal of the Japanese Urological Association. 2024 Aug 23 [Epub ahead of print]
Shuichi Morizane, Jun Miki, Masaki Shimbo, Toru Kanno, Noriyoshi Miura, Yuta Yamada, Takeshi Yamasaki, Takashi Saika, Atsushi Takenaka, A working group for standardization of robot‐assisted pelvic lymph node dissection in the Japanese Society of Endourology and Robotics
Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan., Department of Urology, The Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan., Department of Urology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan., Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan., Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan., Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan., Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan.