Lymph node dissection during robotic‐assisted laparoscopic prostatectomy: comparison of lymph node yield and clinical outcomes when including common iliac nodes with standard template dissection

Abstract

including total number of retrieved and positive LNs in each area of dissection, operative duration and complications. RESULTSOf the 94 patients, 62 underwent standard LND (group 1) and 32 underwent fulltemplate pelvic LND (group 2). The median (mean) number of LNs retrieved in groups 1 and 2 were 12 (13.3) and 17.5 (21.4), respectively. Of the five patients with positive LNs (5%), four were in group 2 (13%); two of these patients had positive LNs in the common iliac dissection, and for one of these patients it was the sole site of involvement. Deep venous thrombosis, pulmonary embolism or transient neuropraxia occurred in six patients (five in group 1 and one in group 2). The median additional operative time for resection of common and internal LNs was 25 min. CONCLUSIONSLN yield increased and additional sites of LN metastases were identified during fulltemplate pelvic LND during RALP. This modification was not associated with an increased rate of complications. Derived benefits of including additional nodal dissection and the effect on staging accuracy remain to be determined.

Complications of Pelvic Lymph Node Dissection for Prostate Cancer

“…While intermediate outcomes demonstrate that laparoscopic RP provides equivalent cancer control and functional outcomes [30], there remains debate regarding the feasibility and oncologic efficacy of laparoscopic PLND. Early laparoscopic PLND series demonstrated slightly higher rates of some complications [31,32]. However, more contemporary series note similar rates of complication compared to open series with ureteral injury and obturator injury occurring less than 1% of the time [25,28,29].…”

“…Nerves that may be injured during PLND include [21,28,32]. The obturator nerve may be injured by cautery, clip, or transection.…”

Extended pelvic lymph node dissection at the time of robot-assisted radical prostatectomy: impact of surgical volume on efficacy and complications in a single-surgeon series.

“…[7][8][9]23,24 In addition, it must be noted that we included all patients in the learning curve and reported any deviation from the intra-and postoperative standard course as complications (including clinically insignificant events, such as asymptomatic lymphoceles not requiring therapy). Without considering those occurrences, our complication rate would drop to 6% (14 adverse events in 14/233 patients).…”

Comparison of Extraperitoneal and Transperitoneal Pelvic Lymph Node Dissection During Minimally Invasive Radical Prostatectomy

“…Initial studies have demonstrated similar oncologic and functional outcomes between transperitoneal and extraperitoneal laparoscopic RP. 11,[13][14][15][16][17] For example, retrospective studies by Porpiglia and coworkers 18 and Eden and colleagues 19 demonstrated faster operative time and increased recovery of continence in patients undergoing an extraperitoneal approach. 18,19 Ruiz and associates 17 demonstrated equivalent immediate oncologic outcomes including pathologic stage and rates of positive surgical margins in men undergoing either transperitoneal or extraperitoneal laparoscopic RP.…”

“…Katz and coworkers 16 found that both standard and extended PLND could be performed via a laparoscopic transperitoneal approach with an acceptable side effect profile. Similarly, Eden and associates 21 demonstrated an advantage of transperitoneal extended PLND over extraperitoneal standard PLND with regard to LNY and %LNI, which is not surprising because it is the templates rather than the approaches that were compared 21 ; no direct comparison was indeed made between similar nodal dissection templates attempted transperitoneally or extraperitoneally.…”