Author's Accepted Manuscript Fluorescence – guided targeted pelvic Lymph node dissection in intermediate and high risk prostate cancer Stephan Hruby , Christine Englberger , Lukas Lusuardi , Tobias Schätz , Thomas Kunit , Ahmed Magdy Abdel-Aal , Martina Hager , Günter Janetschek

PII: DOI: Reference:

S0022-5347(15)03829-X 10.1016/j.juro.2015.03.127 JURO 12539

To appear in: The Journal of Urology Accepted Date: 11 March 2015 Please cite this article as: Hruby S, Englberger C, Lusuardi L, Schätz T, Kunit T, Abdel-Aal AM, Hager M, Janetschek G, Fluorescence – guided targeted pelvic Lymph node dissection in intermediate and high risk prostate cancer, The Journal of Urology® (2015), doi: 10.1016/j.juro.2015.03.127. DISCLAIMER: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our subscribers we are providing this early version of the article. The paper will be copy edited and typeset, and proof will be reviewed before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to The Journal pertain.

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Fluorescence – guided targeted pelvic Lymph

prostate cancer

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node dissection in intermediate and high risk

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Stephan Hruby1, Christine Englberger1, Lukas Lusuardi1, Tobias Schätz1, Thomas Kunit1, Ahmed Magdy Abdel-Aal1, Martina Hager2 and Günter Janetschek1 Departments of Urology1 & Pathology2, Paracelsus Medical University,

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Salzburg, Austria

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Corresponding Author

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Stephan Hruby, MD

Department of Urology Paracelsus Medical University Müllner Hauptstr. 48 5020 Salzburg Austria E-Mail: [email protected]

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References:

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Abstract:

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Take Home Message: 37/40

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Keywords: Prostate Cancer; Sentinel PLND; ICG; Fluorescence guided surgery; Pelvic lymph node dissection; Lymph Node Metastasis; Radical Prostatectomy;

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Descriptive Runninghead: In this report we evaluated the efficacy of a Fluorescene targeted only approach for pelvic lymph node dissection in prostate cancer. The absolute number of nodes removed could be

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reduced whereas the diagnostic accuracy is increased. This can be achieved since fluorescence targeted pelvic lymph node dissection

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allows to identify the individual lymphatic drainage of the prostate with great reliability.

Acknowledgement:

This scientific work is supported by an unrestricted cancer research grant of the “Krebshilfe Salzburg” and the “Prosperamus” grant of the Paracelsus Medical University Salzburg.

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ABSTRACT Purpose: In this study we investigated if visualisation of the drainage system of the

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prostate by free Indocyanin Green (ICG) leads to identification of all or even more lymph node metastases detected by superextended PLND in

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an intermediate and high risk prostate cancer patient population.

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Materials & Methods:

38 consecutive men with intermediate and high risk prostate cancer according to the d´Amico criteria-have undergone fluorescence-targeted pelvic lymph node dissection (ft-PLND) during laparoscopic radical

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prostatectomy. A super-extended PLND (se-PLND) was added as control. Patients with neoadjuvant hormonal therapy, macroscopic lymph

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node involvement or prior TURP were excluded from the study. Statistical descriptive methods, chi-square test, and independent t-test,

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were used for analyzing the data. Results:

The mean age was 64.9(Range 46-74) years, mean preoperative PSA was 13.8 (Range 0.3-44) ng/ml. 23 pat (60.5 %) were classified intermediate, 15 pat (39.5 %) high risk. Fluorescence stained (F+) nodes were found on both sides in all patients except one. In total 700 nodes (mean 18,4 +-8,2 LN/patient) were removed, of which 531 nodes (75% of

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all nodes) were F+ (mean 14 +- 8,07 LN/pat.). Lymph node (LN) metastases were found in 15 patients (39,5%). 2 (5,3%) had a solitary micrometastasis, 3 (7,9%) showed nodes containing isolated tumor

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cells(pNi). Metastases outside the template of e-PLND occurred in 5/15 patients (33,3%). 3 of those 5 reached a PSA Nadir