Introduction: To assess the incidence of malignancy involvement of lymph nodes (LNs) in Marcille’s fossa in patients undergoing robot assisted radical prostatectomy (RARP) and extended pelvic lymph nodes dissection (ePLND) for prostate cancer (PCa). Design, Setting, and Participants: Between January 2014 and December 2017, details of patients who underwent RARP and ePLND were prospectively analysed. All the nodal packets were dissected separately, grouped into left and right nodes and submitted in separate packages to dedicated pathologist. Results and Limitations: Two hundred and twenty-one patients underwent ePLND and RARP in the study period. In aggregate, Marcille’s LNs involvement was found in 5 (2.3%) of patients, 2 on the left side and 3 on the right side. Per cent of positive cores and Gleason at biopsy are clinical predictors of LNs invasion; moreover, in the surgical specimen, seminal vesicle invasion and high-grade cancer were factors related to loco-regional metastases. Conclusions: Marcille’s nodes involvement is associated to contemporarily multiple LN metastases in other template locations in high-risk PCa patients. The Marcille’s lymphadenectomy would be recommended when planning an ePLND in high-risk PCa.

1.
Gil-Vernet JM. Prostate cancer: anatomical and surgical considerations. Br J Urol. 1996 Aug;78(2):161–8.
2.
Heck MM, Retz M, Bandur M, Souchay M, Vitzthum E, Weirich G, et al. Topography of lymph node metastases in prostate cancer patients undergoing radical prostatectomy and extended lymphadenectomy: results of a combined molecular and histopathologic mapping study. Eur Urol. 2014 Aug;66(2):222–9.
3.
Fossati N, Willemse PM, Van den Broeck T, van den Bergh RC, Yuan CY, Briers E, et al. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol. 2017 Jul;72(1):84–109.
4.
Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR, et al. Pelvic lymph node dissection in prostate cancer. Eur Urol. 2009 Jun;55(6):1251–65.
5.
Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017 Apr;71(4):618–29.
6.
Hueting TA, Cornel EB, Somford DM, Jansen H, van Basten JPA Pleijhuis RG, et al. External Validation of Models Predicting the Probability of Lymph Node Involvement in Prostate Cancer Patients. Eur Urol Oncol. 2018 Oct;1(5)411–7.
7.
Kim KH, Lim SK, Koo KC, Han WK, Hong SJ, Rha KH. Extended lymph node dissection in robot-assisted radical prostatectomy: lymph node yield and distribution of metastases. Asian J Androl. 2014 Nov-Dec;16(6):824–8.
8.
Yuh BE, Ruel NH, Mejia R, Wilson CM, Wilson TG. Robotic extended pelvic lymphadenectomy for intermediate- and high-risk prostate cancer. Eur Urol. 2012 May;61(5):1004–10.
9.
Maderthaner L, Furrer MA, Studer UE, Burkhard FC, Thalmann GN, Nguyen DP. More extended lymph node dissection template at radical prostatectomy detects metastases in the common iliac region and in the fossa of Marcille. BJU Int. 2018 May;121(5):725–31.
10.
Ventimiglia E, Briganti A, Montorsi F. Lymph node dissection during radical prostatectomy for prostate cancer: extending the template in the right patients without increasing complications. BJU Int. 2018 May;121(5):677–8.
11.
Lee P, Francis KE, Solomon MJ, Ramsey-Stewart G, Austin KK, Koh C. Triangle of Marcille: the anatomical gateway to lateral pelvic exenteration. ANZ J Surg. 2017 Jul;87(7-8):582–6.
12.
Marcille M. Lymphatiques et ganglions ilio-pelviens. Université de Paris; 1902.
13.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205–13.
14.
D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998 Sep;280(11):969–74.
15.
Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol. 2012 Mar;61(3):480–7.
16.
Porcaro AB, de Luyk N, Corsi P, Sebben M, Tafuri A, Mattevi D, et al.; Clinical Factors Predicting and Stratifying the Risk of Lymph Node Invasion in Localized Prostate Cancer. Clinical Factors Predicting and Stratifying the Risk of Lymph Node Invasion in Localized Prostate Cancer. Urol Int. 2017;99(2):207–14.
17.
Porcaro AB, de Luyk N, Corsi P, Sebben M, Tafuri A, Tamanini I, et al. Bilateral lymph node micrometastases and seminal vesicle invasion associated with same clinical predictors in localized prostate cancer. Tumori. 2017 May;103(3):299–306.
18.
Porcaro AB, Siracusano S, de Luyk N, Corsi P, Sebben M, Tafuri A, et al. Low-Risk Prostate Cancer and Tumor Upgrading in the Surgical Specimen: Analysis of Clinical Factors Predicting Tumor Upgrading in a Contemporary Series of Patients Who were Evaluated According to the Modified Gleason Score Grading System. Curr Urol. 2017 Aug;10(3):118–25.
19.
Porcaro AB, Inverardi D, Corsi P, Sebben M, Cacciamani G, Tafuri A, et al. Prostate specific antigen levels and proportion of biopsy positive cores are independent predictors of upgrading patterns in low risk prostate cancer. Minerva Urol Nefrol. 2018, Epub ahead of print.
20.
Srigley JR, Humphrey PA, Amin MB, Chang SS, Egevad L, Epstein JI, et al.; Members of the Cancer Committee, College of American Pathologists. Protocol for the examination of specimens from patients with carcinoma of the prostate gland. Arch Pathol Lab Med. 2009 Oct;133(10):1568–76.
21.
Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA; Grading Committee. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016 Feb;40(2):244–52.
22.
Pini G, Matin SF, Suardi N, Desai M, Gill I, Porter J, et al. Robot assisted lymphadenectomy in urology: pelvic, retroperitoneal and inguinal. Minerva Urol Nefrol. 2017 Feb;69(1):38–55.
23.
Cacciamani GE, Porcaro AB, Sebben M, Tafuri A, Rizzetto R, De Luyk N, et al. Extended pelvic lymphadenectomy for prostate cancer: should the cloquet’s nodes dissection be considered only an option? Minerva Urol Nefrol. 2019, Epub ahead of print.
24.
Joniau S, Van den Bergh L, Lerut E, Deroose CM, Haustermans K, Oyen R, et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol. 2013 Mar;63(3):450–8.
25.
Eden CG, Arora A, Rouse P. Extended vs standard pelvic lymphadenectomy during laparoscopic radical prostatectomy for intermediate- and high-risk prostate cancer. BJU Int. 2010 Aug;106(4):537–42.
26.
Briganti A, Chun FK, Salonia A, Gallina A, Farina E, Da Pozzo LF, et al. Validation of a nomogram predicting the probability of lymph node invasion based on the extent of pelvic lymphadenectomy in patients with clinically localized prostate cancer. BJU Int. 2006 Oct;98(4):788–93.
27.
Heidenreich A, Ohlmann CH, Polyakov S. Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy. Eur Urol. 2007 Jul;52(1):29–37.
28.
Ramírez-Backhaus M, Mira Moreno A, Gómez Ferrer A, Calatrava Fons A, Casanova J, Solsona Narbón E, et al. Indocyanine Green Guided Pelvic Lymph Node Dissection: An Efficient Technique to Classify the Lymph Node Status of Patients with Prostate Cancer Who Underwent Radical Prostatectomy. J Urol. 2016 Nov;196(5):1429–35.
29.
Nguyen DP, Huber PM, Metzger TA, Genitsch V, Schudel HH, Thalmann GN. A Specific Mapping Study Using Fluorescence Sentinel Lymph Node Detection in Patients with Intermediate- and High-risk Prostate Cancer Undergoing Extended Pelvic Lymph Node Dissection. Eur Urol. 2016 Nov;70(5):734–7.
30.
Osmonov DK, Boller A, Aksenov A, Naumann M, Jünemann KP. [Intermediate and high risk prostate cancer patients. Clinical significance of extended lymphadenectomy]. Urologe A. 2013 Feb;52(2):240–5.
31.
Zehnder P, Desai M. Extended lymph node dissection: bladder, kidney. Curr Opin Urol. 2011 Mar;21(2):110–4.
32.
Kitamura H, Masumori N, Tsukamoto T. Role of lymph node dissection in management of bladder cancer. Int J Clin Oncol. 2011 Jun;16(3):179–85.
33.
Roth B, Burkhard FC. The Role of Lymphadenectomy in Radical Cystectomy. Eur Urol Suppl. 2010;9(1):19–24.
34.
Porcaro AB, De Luyk N, Corsi P, Sebben M, Tafuri A, Processali T, et al. Clinical factors predicting bilateral lymph node invasion in high-risk prostate cancer. Urol Int. 2017;99(4):392–9.
You do not currently have access to this content.