Ashish M. Kamat: Our collaborative review on Lymph Node Dissection in GU cancers

Ashish M. Kamat, Professor of Urologic Oncology (Surgery) and Cancer Research at M.D. Anderson Cancer Center, shared a post on X/Twitter:

“Our collaborative review on Lymph Node Dissection in GU cancers; tremendous effort by Amanda Myers MD Anderson Cancer Center

For bladder cancer
Pivotal RCTs (SWOG S1011 and LEA) show no survival gain with Ext. PLND. The 2023 standard: A meticulous LND of the obturator fossa, internal and external iliac landing zones. PLND essential in detecting occult LN mets, imaging remains subpar

Fig. 1 – PLND templates: (A) PLND recommended for bladder and prostate cancer inclusive of the obturator fossa, external iliac, and internal iliac nodes. This is referred to as standard PLND for bladder cancer and extended PLND by EAU guidelines for prostate cancer. (B) An ePLND template in bladder cancer also includes the common iliac and presacral nodes. (C) Superextended PLND used in the LEA trial. The ePLND in SWOG S1011 included all nodes at least to the aortic bifurcation (B) and up to the IMA based on surgeon preference (C)

Prostate: PLND templates lack consensus; terminology not uniform. Risk stratification key and nomograms now incorporate PSMA Giorgio Gandaglia, Alberto Briganti
Ongoing de-escalation trials awaited. – PLND vs no PLND trials: PREDICT Martini-Klinik am UKE and Karim Touijer UrologyMSK
– PSMA stratified trials: Dutch national -PSMA-select and The Netherlands Cancer Institute study

Penile Ca: Timely LND can be lifesaving. ILND w/in 3 months of dx improves survival. For high-risk cN0 patients, early detection and LNY matters Philippe Spiess, Juan Chipollini, Giuseppe Fallara
High volume centers show success of sentinel node biopsies and potentially spare men from more extensive surgeries. For those w/o access, ILND still global standard. Oscar Brouwer

For advanced penile cancer, InPACT trial will eval postchemo ILND Curtis Pettaway, Paul Hego, Gagan Prakash

Fig. 3. (A) Radical ILND with sparing of the saphenous vein when feasible. (B) Fascial-sparing ILND; the fascia lata is preserved, and deep inguinal nodes can be dissected medial to the femoral vein just distal to the fossa ovalis, if necessary”