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Volume 15
Issue 12
10.3390/jcm15124614
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Brief Report

Assessment of Presence and Metastatic Involvement of Lymph Nodes in Anterior Periprostatic Fat (APPF) in Prostate Cancer Patients Treated with Robotic and Laparoscopic Radical Prostatectomy

by
Mudassir Wani
1,2,
Jayasimha Abbaraju
3,
Bikram Bhattacharjee
4,
Abdousamad Said Omar
5,
Hasan Al-Chalabi
6 and
Sanjeev Madaan
2,3,*
1
Department of Urology, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
2
Faculty of Social and Applied Sciences, Canterbury Christ Church University, Chatham ME4 4UF, UK
3
Department of Urology & Nephrology, Dartford and Gravesham NHS Trust, Dartford DA2 8DA, UK
4
Department of Radiology, Dartford and Gravesham NHS Trust, Dartford DA2 8DA, UK
5
Department of Surgery, Aneurin Bevan University Health Board, Newport NP18 3XQ, UK
6
Department of Urology, Aneurin Bevan University Health Board, Newport NP18 3XQ, UK
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(12), 4614; https://doi.org/10.3390/jcm15124614 (registering DOI)
Submission received: 21 May 2026 / Revised: 7 June 2026 / Accepted: 12 June 2026 / Published: 14 June 2026
(This article belongs to the Special Issue The New Era of Urological Surgery: Technology-Enhanced Clinical Outcomes)
Versions Notes

Abstract

Introduction: Lymph nodes (LN) in the anterior periprostatic fat (APPF) may harbour metastatic disease in patients with Prostate Cancer (PCa). We investigated the incidence and significance of LN in APPF tissue removed during robotic and laparoscopic radical prostatectomy (RP). Patients and Methods: We retrospectively analysed RP performed by a single surgeon from 2013 to 2023. A total of 670 patients underwent RP, with 407 procedures conducted laparoscopically and 263 robotically. Histological results were available for 509 patients, who were examined for the presence of LN and any evidence of metastatic involvement. Results: LN were detected in the periprostatic fat of eighty patients; however, only twelve had lymph node metastasis. Seven of the twelve patients presented with prostate-specific antigen (PSA) levels greater than 10 ug/L. All LN-positive patients had a Gleason score of seven or higher. On MRI, all patients had a PIRADS score of four or higher, and eleven were staged at T3 or higher. Additionally, all twelve patients had a Briganti score exceeding twenty. Conclusions: Our series indicates that the APPF contains LN that can harbour metastatic disease. Patients can have LN involved in APPF without the involvement of pelvic LN. Therefore, our study suggests that routine excision of APPF should be considered for appropriate LN staging and to avoid missing any metastasis, and that scoring systems like Briganti should be used to help identify this high-risk group.
Keywords: anterior periprostatic fat; lymph nodes; radical prostatectomy anterior periprostatic fat; lymph nodes; radical prostatectomy

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MDPI and ACS Style

Wani, M.; Abbaraju, J.; Bhattacharjee, B.; Omar, A.S.; Al-Chalabi, H.; Madaan, S. Assessment of Presence and Metastatic Involvement of Lymph Nodes in Anterior Periprostatic Fat (APPF) in Prostate Cancer Patients Treated with Robotic and Laparoscopic Radical Prostatectomy. J. Clin. Med. 2026, 15, 4614. https://doi.org/10.3390/jcm15124614

AMA Style

Wani M, Abbaraju J, Bhattacharjee B, Omar AS, Al-Chalabi H, Madaan S. Assessment of Presence and Metastatic Involvement of Lymph Nodes in Anterior Periprostatic Fat (APPF) in Prostate Cancer Patients Treated with Robotic and Laparoscopic Radical Prostatectomy. Journal of Clinical Medicine. 2026; 15(12):4614. https://doi.org/10.3390/jcm15124614

Chicago/Turabian Style

Wani, Mudassir, Jayasimha Abbaraju, Bikram Bhattacharjee, Abdousamad Said Omar, Hasan Al-Chalabi, and Sanjeev Madaan. 2026. "Assessment of Presence and Metastatic Involvement of Lymph Nodes in Anterior Periprostatic Fat (APPF) in Prostate Cancer Patients Treated with Robotic and Laparoscopic Radical Prostatectomy" Journal of Clinical Medicine 15, no. 12: 4614. https://doi.org/10.3390/jcm15124614

APA Style

Wani, M., Abbaraju, J., Bhattacharjee, B., Omar, A. S., Al-Chalabi, H., & Madaan, S. (2026). Assessment of Presence and Metastatic Involvement of Lymph Nodes in Anterior Periprostatic Fat (APPF) in Prostate Cancer Patients Treated with Robotic and Laparoscopic Radical Prostatectomy. Journal of Clinical Medicine, 15(12), 4614. https://doi.org/10.3390/jcm15124614

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