Outcomes and complications of pelvic lymph node dissection during robotic-assisted radical prostatectomy

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 prospective...

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Bibliographic Details
Published in:World journal of urology 2013-06, Vol.31 (3), p.481-488
Main Authors: Liss, Michael A., Palazzi, Kerrin, Stroup, Sean P., Jabaji, Ramzi, Raheem, Omer A., Kane, Christopher J.
Format: Article
Language:English
Subjects:
Aged
Humans
Incidence
Laparoscopy - methods
Lymph Node Excision - adverse effects
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphatic Metastasis - pathology
Lymphocele - epidemiology
Lymphocele - pathology
Male
Medicine
Medicine & Public Health
Middle Aged
Nephrology
Oncology
Pelvis - surgery
Prostatectomy - methods
Prostatic Neoplasms - surgery
Retrospective Studies
Risk Factors
Robotics - methods
Topic Paper
Treatment Outcome
Urology
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Summary: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.
ISSN:0724-4983
1433-8726
DOI:10.1007/s00345-013-1056-9