How many lymph nodes should be taken out during RALP surgery

It's controversial, and is not always done at all in the US. It depends on your risk of lymph node invasion. (Please add a signature). When they do an extended pelvic lymph node dissection (ePLND), they take out as many as they can find, usually between 15 and 30. They're hard to find, and they never get them all. The side effects may include lymphocele and lymphedema.

Three were removed during my RP.

Three in my RP as well. Even with only 3, I ended up with a lymphocele, which was no fun, though it eventually went away on its own. Incidence of lymphocele post-RP is about 7-8 percent, but I haven't seen a breakdown based on the number of LNs removed. Though one would imagine the more LNs dissected, the higher the chance of developing a lymphocele or lymphedema, I don't know if any studies have borne that out.

As TA says, the jury's still out on whether and when extensive PLND is warranted. Proponents claim it helps guide post-RP treatment decisions if the cancer persists or recurs, and even that it yields better survival outcomes. Cynics say many surgeons don't like to do ePLND only because it takes too much time and cuts into their earnings. On the other hand, "Do no harm" is a great plan.

If you've decided on surgery as primary treatment, when interviewing surgeons I'd suggest asking them their view on the subject generally, and specifically whether they plan on PLND or ePLND for you and why. There's no right answer to these questions, but open dialog on all matters on your mind about the surgery will help you establish trust with the surgeon and make a choice you're comfortable with.

In the US, ePLND is only recommended as an option in unfavorable risk PC. Usually, they would fill out a nomogram for you and anything above a 2% chance of positive lymph nodes would get an ePLND. Your odds of LN involvement are about 11%, so you would qualify for an ePLND.

/www.mskcc.org/nomograms/prostate/pre_op

But even an ePLND is not very good at finding all the cancerous LNs. You may be interested in the section in the article below titled "Surgical pelvic lymph node dissection:

/pcnrv.blogspot.com/2017/01/were-still-not-very-good-at-finding.html

In deciding whether to use whole pelvic radiation, the "Roach formula" is popular:
Prob. of LN involvement = 2/3*PSA + 10*(GS-6), which would be 23% for you. Anything over 15% is cause to use whole pelvic radiation.

I had 29 dissected all negative...got 2 lyphocells bout 2 mos post op self resolved...minor ..fever...malaise...I went in as 3+4 no big ting...I was at the DUB in state of Washington...teaching hospital...I was the host...4 1/2 op...out in 36 hours open doncha know...walked 2 miles to local apt wid da wife...ez breezy....I see it as a "firewall" special with a gleason 9 up grade at the hotel California...toodles...oodles of noodles...

According to the updated Yale version of the Roach formula my chance of lymph note involvement is 14%

I had no idea my lymph nodes were going to be removed - it was never a topic of discussion. I suspect the surgeon thought after looking at the pre-surgery MRI with coil, I was higher risk. Maybe once he got inside that might have been the incentive to remove a bunch.

One thing that still irks me is there was never a mention of the possible side effects like lymphedema. My legs were quite swollen a few months post-surgery and when I showed my RO, she had no remark or comment. So it was up to me to again be my own advocate. My primary care Doc at the VA saw the lymphedema and ordered a pneumatic compression garment to use. It's been very effective at keeping the swelling to a minimum.

Great question. I raised this question as part of a different thread.

For my RP , 6 LNs were removed. All negative. But three of them turned out NOT as Lymph nodes.

This is what came up for 3 of the LNs examined

A. ADIPOSE TISSUE (PERIPROSTATIC LYMPH NODE).

NOTE: No lymph node tissue is identified.

I had 4 peri-prostatic nodes and 10 pelvic nodes removed. I requested this pre-operatively. Not the specific number but that fact that I wanted to have nodes sampled. I actually told the chief resident that this could be his job. All were negative for any prostate cancer. I do not have any type of complications associated with lymphedema.

Hero

They only took one lymph node, he stopped there because as he put it. "It looked normal, so I only took one, and left the rest"

It was positive, good thing he picked the right one.

FYI - I was a pre-surgery Gleason 8.