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

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Abstract

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.

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Conflict of interest

Dr. Kane is a consultant or has received honoraria from Amgen Inc., Janssen Inc, Dendreon Inc. and Intuitive Inc.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, UC San Diego Health System, 200 West Arbor Drive #8897, San Diego, CA, 92103-8897, USA

    Michael A. Liss, Kerrin Palazzi, Ramzi Jabaji, Omer A. Raheem & Christopher J. Kane

  2. Naval Medical Center San Diego, San Diego, CA, USA

    Sean P. Stroup

  3. Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA

    Christopher J. Kane

Authors
  1. Michael A. Liss
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  2. Kerrin Palazzi
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  3. Sean P. Stroup
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  6. Christopher J. Kane
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Correspondence to Christopher J. Kane.

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Liss, M.A., Palazzi, K., Stroup, S.P. et al. Outcomes and complications of pelvic lymph node dissection during robotic-assisted radical prostatectomy. World J Urol 31, 481–488 (2013). https://doi.org/10.1007/s00345-013-1056-9

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  • DOI: https://doi.org/10.1007/s00345-013-1056-9

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