Technical Advances to Lymph Node Dissection: Minimizing Complications

Pelvic lymph node dissection (PLND) is the most accurate staging for lymph node invasion in localized prostate cancer. It plays an important role in the staging and prognostication of prostate cancer; however, its therapeutic benefit is unknown. In this chapter, we describe the limits of PLND with its oncological benefits and complications. To minimize these complications, there have been advances in imaging for lymph node detection preoperatively using MRI and functional imaging tools such as PSMA PET scan. We also discuss the role of sentinel lymph node biopsy and PSMA-guided radiosurgery intraoperatively that facilitate accurate detection of lymph node involvement. Finally, we elaborate on the role of minimally invasive surgical techniques to improve outcomes after PLND.