Pelvic lymph node dissection (PLND) has a role in the treatment of several genitourinary cancers but is most commonly used in bladder cancer and prostate cancer. Others include urethral cancer and penile cancer. PLND has an additional role in the management of gynecologic cancers and other pelvic malignancies. While the anatomic approach is similar, the focus of this article is urologic indications.

History of the procedure
After it had been demonstrated that patients with breast and colon cancer with lymph node metastases could be cured surgically, attempts were made to apply lymphadenectomy to cancers of the pelvic organs. In 1932, Godard and Kaliopoulos reported pelvic lymphadenectomy with total cystectomy for bladder cancer. In 1950, Leadbetter and Cooper also were proponents of pelvic lymphadenectomy with cystectomy for bladder cancer.

Indications
The principal urologic indications for PLND occur in bladder cancer and in prostate cancer. Other urologic scenarios in which PLND is performed include selected cases of urethral and penile cancer.

Bladder cancer
In bladder cancer, pelvic lymph node dissection (PLND) is performed at the time of a radical cystectomy or a partial cystectomy. For these patients, PLND provides staging information and can be therapeutic. Several studies, including by Skinner and Vieweg et al, have confirmed that patients with pelvic lymph node metastases can be cured with PLND during radical cystectomy. However, the curability seemed to hold for organ-confined cancer (pathologic T stage 2) but not for non–organ-confined cancer (pathologic T stage 3).

Prostate cancer
The decision to perform PLND for prostate cancer prior to performing radical retropubic prostatectomy is based on the probability of pelvic lymph node metastases. This can be determined using the Partin nomograms. The Partin nomograms are included in the tables below (these and other nomograms are available at the Prediction Tools Page of MSKCC.org).

Complications of Pelvic Lymphadenectomy: Do the Risks Outweigh the Benefits?
The American Urological Association Best Practice Policy states that although pelvic lymph node dissection (PLND) is commonly done with radical prostatectomy, its morbidity must be considered, particularly in cases in which it offers little additional information. The benefits of PLND include more accurate staging and reassurance for the patient. In addition, PLND may be therapeutic for men with lymph node metastases and may result in long-term biochemical cure for selected node-positive patients. However, the incidence of node positivity is declining, and accordingly a greater number of lymphadenectomies must be performed to benefit 1 patient. In addition to the associated cost, PLND has the potential for morbidity, including lymphoceles, thromboembolic events, ureteral injury, and neurovascular injury. Patients and physicians should therefore assess the risk/benefit ratio associated with PLND on an individual basis to permit informed treatment decisions.


laparoscopic bilateral pelvic lymphnode dissection in a case of endometrial cancer.


References:
http://emedicine.medscape.com/article/446463-overview
Complications of Pelvic Lymphadenectomy: Do the Risks Outweigh the Benefits?