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Fluorescence-guided extended pelvic lymphadenectomy during robotic radical prostatectomy

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Abstract

We evaluated and described the impact of prostatic indocyanine green (ICG) injection on extended pelvic lymph node (LN) dissection (ePLND) in robotic-assisted radical prostatectomy (RARP). Between January 2019 and December 2021, we included consecutive 50 PCa patients who underwent ePLND during RARP with (n = 25) or without (n = 25) prostatic ICG injection. ICG injection was performed during abdominal port placement and robot docking. Pelvic LNs reflecting green color were initially excised and then the template was completed. The outcomes of two groups were compared. Overall, nine (36%) and five (20%) of the patients had metastatic LN involvement in the ICG and non-ICG groups, respectıvely. Of the 509 dissected LNs in the ICG group, 122 (23.9%) were fluorescence active. 20 LNs (3.9%) were metastatic in this group, 9 (45%) of which were ICG+. 408 LNs were resected on the non-ICG group with 8(1.9%) being metastatic. Eight (88.9%) of nine pN+ patients were florescent positive in the ICG group. Out of six patients with pN+ disease, Ga68 PSMA-PET/CT detected positive LNs preoperatively. In addition to preoperative Ga68 PSMA-PET/CT investigation, ICG-guided ePLND might increase identification and removal of metastatic LNs duirng RARP. Improvements ın stagıng and oncologıc outcomes may also be seen ın intermediate- and high-risk patients.

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Funding

The authors declare that this study has received no financial support.

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Authors and Affiliations

  1. Department of Urology, Koç University Hospital, İstanbul, Turkey

    Arif Özkan, Ersin Köseoğlu, Abdullah Erdem Canda, İbrahim Can Aykanat, Ahmet Furkan Sarıkaya, Kayhan Tarım, Yakup Kordan, Mevlana Derya Balbay & Tarık Esen

  2. Department of Radiology, Koç University Hospital, İstanbul, Turkey

    Barbaros Erhan Çil

  3. Department of Pathology, Koç University Hospital, İstanbul, Turkey

    Ayse Armutlu, İbrahim Kulaç & Dilek Ertoy Baydar

  4. Koç University School of Medicine, İstanbul, Turkey

    Erinç Barçın

  5. Department of Nuclear Medicine and Molecular Imaging, Koç University Hospital, İstanbul, Turkey

    Fikri Okan Falay

Authors
  1. Arif Özkan
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  2. Ersin Köseoğlu
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  3. Abdullah Erdem Canda
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  5. İbrahim Can Aykanat
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  6. Ahmet Furkan Sarıkaya
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  7. Kayhan Tarım
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  14. Mevlana Derya Balbay
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  15. Tarık Esen
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Contributions

Surgical and medical practices—AEC, BEÇ, AA, İK, DEB, FF, AÖ; concept—AEC, MDB, YK, TE; design—AÖ, AEC, TE; data collection and/or processing—AÖ, BEÇ, İK, AA, DEB, FOF; analysis and/or interpretation—KT, AFS, EB; literature search—AÖ, İCA; writing—AÖ, TE.

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Correspondence to Arif Özkan.

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Preliminary part of this work received a 2nd Best Poster Prize during ERUS-DRUS21 Meeting, 11–13 November 2021, Dusseldorf, Germany.

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Supplementary file1ICG guided extended pelvic lymph node dissection during robot assisted radical prostatectomy (MP4 1667269 kb)

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Özkan, A., Köseoğlu, E., Canda, A.E. et al. Fluorescence-guided extended pelvic lymphadenectomy during robotic radical prostatectomy. J Robotic Surg 17, 885–890 (2023). https://doi.org/10.1007/s11701-022-01480-z

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  • DOI: https://doi.org/10.1007/s11701-022-01480-z

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