^(68)Ga-PSMA ligand PET/CT integrating indocyanine green-guided salvage lymph node dissection for lymph node metastasis after radical prostatectomy

To efficiently remove all recurrent lymph nodes(rLNs)and minimize complications,we developed a combination approach that consisted of ^(68)Gallium prostate-specific membrane antigen(PSMA)ligand positron emission tomography(PET)/computed tomography(CT)and integrated indocyanine green(ICG)-guided salvage lymph node dissection(sLND)for rLNs after radical prostatectomy(RP).Nineteen patients were enrolled to receive such treatment.^(68)Ga-PSMA ligand PET/CT was used to identify rLNs,and 5 mg of ICG was injected into the space between the rectum and bladder before surgery.Fluorescent laparoscopy was used to perform sLND.While extensive LN dissection was performed at level I,another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal,and laparoscopy was introduced to intensively target stained LNs along levels I and II,specifically around suspicious LNs,with ^(68)Ga-PSMA ligand PET/CT.Next,both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV.In total,pathological analysis confirmed that 42 nodes were rLNs.Among 145 positive LNs stained with ICG,24 suspicious LNs identified with ^(68)Ga-PSMA ligand PET/CT were included.The sensitivity and specificity of ^(68)Ga-PSMA ligand PET/CT for detecting rLNs were 42.9%and 96.6%,respectively.For ICG,the sensitivity was 92.8%and the specificity was 39.1%.At a median follow-up of 15(interquartile range[IQR]:6–31)months,15 patients experienced complete biochemical remission(BR,prostate-specific antigen[PSA]<0.2 ng ml−1),and 4 patients had a decline in the PSA level,but it remained>0.2 ng ml−1.Therefore,^(68)Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.

Potential benefit of lymph node dissection during radical nephrectomy for kidney cancer:A review and critical analysis of current literature

Objective:The role of lymph node dissection(LND)is still controversial in patients with renal cell carcinoma undergoing surgery.We aimed to provide a comprehensive review of the literature about the effect of LND on survival,prognosis,surgical outcomes,as well as patient selection and available LND templates.Methods:Recent literature(from January 2011 to December 2021)was assessed through PubMed and MEDLINE databases.A narrative review of most relevant articles was provided.Results:The frequencies in which LNDs are being carried out are decreasing due to an increase in minimally invasive and nephron sparing surgery.Moreover,randomized clinical trials and meta-analyses failed to show any survival advantage of LND versus no LND.However,retrospective studies suggest a survival benefit of LND in high-risk patients(bulky tumors,T3-4 stage,and cN1 patients).Moreover,extended LND might provide important staging information,which could be of interest for adjuvant treatment planning.Conclusion:No level 1 evidence of any survival advantage deriving from LND is currently available in literature.Thus,the role of LND is limited to staging purposes.However,low grade evidence suggests a possible role of LND in high-risk patients.Randomized clinical trials are warranted to corroborate these findings.