Extended versus standard pelvic lymphadenectomy during robot-assisted radical prostatectomy: the role of extended template as an independent predictor of lymph node invasion with comparable morbidity burden

Mistretta, Francesco A.; Boeri, Luca; Grasso, Angelica; Russo, V. Lo; Albo, G.; Lorenzis, E. De; Maggioni, Marco; Palmisano, Franco; Dell’Orto, P.; Bòsari, Silvano; Rocco, Bernardo

doi:10.23736/s0393-2249.17.02838-7

Cited by 9 publications

(3 citation statements)

References 24 publications

(31 reference statements)

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“…A total of 70.6% of patients, including 876 (56.9%) patients with low/intermediate‐risk PCa and 957 (82.4%) with high‐risk PCa, underwent PLND (Table 2). In addition, the range of lymphadenectomy was extended in 317 patients (16.8%), standard in 247 (13.1%), and limited in 1322 (70.1%) 17,18 …”

Section: Resultsmentioning

confidence: 99%

“…In addition, the range of lymphadenectomy was extended in 317 patients (16.8%), standard in 247 (13.1%), and limited in 1322 (70.1%). 17,18 RARP-related perioperative complications were identified in 198 patients (7.4%), including 69 patients (2.6%) with grade 3/4 complications according to the Clavien-Dindo classification (Table 3). The most common surgery-related complication in this study was urinary leakage at the urethrovesical anastomosis.…”

Section: Surgical Outcomesmentioning

confidence: 99%

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Short‐term oncological and surgical outcomes of robot‐assisted radical prostatectomy: A retrospective multicenter cohort study in Japan (the MSUG94 group)

Kato

Ebara

Tatenuma

et al. 2022

Asian J Endoscop Surgery

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Introduction: We evaluated oncological outcomes of patients undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) and their perioperative complications in Japan. We investigated clinical and pathological covariates to predict biochemical recurrence (BCR) after RARP.Methods: A retrospective multicenter cohort study was conducted in RARP patients with PCa at 10 institutions in Japan. Pre-and postoperative covariates were collected from enrolled patients. The primary endpoint was defined as biochemical recurrence-free survival (BRFS). Additionally, the association between BCR and clinicopathological covariates was determined.Results: We enrolled 2670 patients in this study. The median follow-up period was 26.0 months. RARP-related perioperative complications were identified in 198 patients (7.4%), including 69 patients (2.6%) with grade 3/4 complications according to the Clavien-Dindo classification. The 2-year BRFS was 88.0%.Using the Kaplan-Meier method, initial prostate-specific antigen (PSA) level of ≤7.6 ng/mL, biopsy and pathological Gleason score (GS) of ≤7, clinical and pathological T1/2, and low/intermediate risks according to the National Comprehensive Cancer Network risk classification, and negative surgical margin status had significant BRFS than their counterparts. In multivariate analysis, initial PSA, biopsy and pathological GS, clinical and pathological T stage, and surgical margin status significantly correlated with BCR after RARP. Conclusion: In this study, RARP achieved a lower incidence of perioperative complications than other studies. K E Y W O R D Soncological outcomes and perioperative complications, prostate cancer, robot-assisted radical prostatectomy

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Section: Resultsmentioning

confidence: 99%

Section: Surgical Outcomesmentioning

confidence: 99%

Short‐term oncological and surgical outcomes of robot‐assisted radical prostatectomy: A retrospective multicenter cohort study in Japan (the MSUG94 group)

Kato

Ebara

Tatenuma

et al. 2022

Asian J Endoscop Surgery

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“…Different studies have demonstrated that extended PLND (ePLND) provides better pathological staging in PC compared to limited PLND (lPLND) or standard PLND (sPLND). [22][23][24] Therefore, present guidelines recommend ePLND if PLND is being considered.…”

Section: Discussionmentioning

confidence: 99%

Effect of pelvic lymph node dissection and its extent on oncological outcomes in intermediate‐risk prostate cancer patients: A multicenter study of the Turkish Uro‐oncology Association

İzol

Aslan

et al. 2022

The Prostate

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Background Pelvic lymph node dissection (PLND) is the gold standard method for lymph node staging in prostate cancer. We aimed to evaluate the effect of PLND combined with radical prostatectomy (RP) on oncological outcomes in D'Amico intermediate‐risk prostate cancer (IRPC) patients. Methods Patients with D'Amico IRPC were included in the study. In the overall cohort and subgroups (biopsy International Society of Urological Pathology [ISUP] grade group 2 and 3), patients were divided into two groups as PLND and no‐PLND. More extensive PLND, defined as a number of removed nodes (NRN) ≥ 75th percentile. Results After exclusion, a total of 631 patients were included: 351 (55.6%) had PLND and 280 (44.4%) had no‐PLND. The mean age was 63.1 ± 3.60 years. The median NRN was 8.0 (1.0–40.0). The mean follow‐up period was 47.7 ± 37.5 months. The lymph node involvement (LNI) rate was 5.7% in the overall cohort, 3.9% in ISUP grade 2, and 10.8% in ISUP grade 3. Patients with PLND were associated with more aggressive clinicopathologic characteristics but no significant difference in biochemical recurrence‐free survival (BCRFS) was found between patients with PLND and no‐PLND (p = 0.642). In the subgroup analysis for ISUP grades 2 and 3, no significant difference in BCRFS outcomes was found in patients with PLND and No‐PLND (p = 0.680 and p = 0.922). Also, PLND extent had no effect on BCRFS (p = 0.569). The multivariable Cox regression model adjusted for preoperative tumor characteristics revealed that prostate specific antigen (PSA) (HR: 1.18, 95% CI: 1.01–1.25; p = 0.048) was an independent predictor of biochemical recurrence (BCR). The optimum cut‐off value for PSA, which can predict BCRFS, was assigned to be 7.81 ng/ml, with an AUC of 0.63 (95% CI: 0.571–0.688). The highest sensitivity and specificity were 0.667 and 0.549. Conclusion Overall and cancer‐specific survival analyzes were not evaluated because not enough events were observed. Neither PLND nor its extent improved BCRFS outcomes in IRPC. The LNI rate is low in patients with biopsy ISUP grade 2 and the BCR rate is low in those with PSA < 7.81 ng/dl so PLND can be omitted in these IRPC patients.

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Frecuencia de PSA indetectable en pacientes con cáncer de próstata N+ baja carga tras prostatectomía radical y linfadenectomía ampliada

Ramírez‐Backhaus

Maresma

Mascarós

et al. 2019

Actas Urológicas Españolas

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Extended versus standard pelvic lymphadenectomy during robot-assisted radical prostatectomy: the role of extended template as an independent predictor of lymph node invasion with comparable morbidity burden

Cited by 9 publications

References 24 publications

Short‐term oncological and surgical outcomes of robot‐assisted radical prostatectomy: A retrospective multicenter cohort study in Japan (the MSUG94 group)

Short‐term oncological and surgical outcomes of robot‐assisted radical prostatectomy: A retrospective multicenter cohort study in Japan (the MSUG94 group)

Effect of pelvic lymph node dissection and its extent on oncological outcomes in intermediate‐risk prostate cancer patients: A multicenter study of the Turkish Uro‐oncology Association

Frecuencia de PSA indetectable en pacientes con cáncer de próstata N+ baja carga tras prostatectomía radical y linfadenectomía ampliada

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