PURPOSE: Describe the outcomes and complications of patients who underwent standard pelvic lymphadenectomy (SPLND) and extended PLND (EPLND), or who did not undergo PLND (non-PLND) at the time of robotic-assisted laparoscopic radical prostatectomy (RALP).
METHODS: Retrospective analysis of prospectively collected longitudinal data of 492 RALPs performed by a single surgeon (Kane) over a 5-year period. Patients are subdivided into three treatment groups: 54 EPLND; 231 SPLND; and 207 non-PLND. Indications for EPLND include Gleason score ≥8, PSA ≥10 ng/mL, and higher D'Amico risk group. Patient demographics, perioperative complications, and short-term oncologic outcomes are compared.
RESULTS: Patients who underwent EPLND had higher-risk prostate cancer as evidenced by higher mean PSA (8.5 ng/mL), biopsy Gleason sum (≥8) (57.7 %), and D'Amico risk group (75.9 %), compared to SPLND and/or non-PLND groups (p ≤ 0.001). The EPLND total lymph node yield was similar compared to SPLND (20 vs. 18; p = 0.070). When the EPLND (n = 41) and SPLND (n = 57) were examined among only high-risk patients, the lymph node (IQR) yields [20 (14-29) vs. 17 (12-23)] and the proportion of positive nodes [29.3 % (12/41) vs. 12.3 % (7/57)] differed significantly (p = 0.048 and p = 0.042, respectively). Complication rates for all groups were similar and lymphocele formation was 5 %; 2.5 % were clinically significant.
CONCLUSIONS: Robotic PLND can be performed with nodal yield comparable to open or laparoscopic PLND. Robotic EPLND improves nodal yield and the proportion of high-risk patients with nodal metastases recognized. Robotic PLND is associated with an approximately 5 % lymphocele rate. There is no difference in complications between EPLND and SPLND.
Written by:
Liss MA, Palazzi K, Stroup SP, Jabaji R, Raheem OA, Kane CJ. Are you the author?
Division of Urology, Department of Surgery, UC San Diego Health System, 200 West Arbor Drive #8897, San Diego, CA, 92103-8897, USA.
Reference: World J Urol. 2013 Mar 20. Epub ahead of print.
doi: 10.1007/s00345-013-1056-9
PubMed Abstract
PMID: 23512231
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