Robotic-assisted pelvic lymph node dissection for prostate cancer: frequency of nodal metastases and oncological outcomes
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Limited data are available regarding the oncologic efficacy of pelvic lymph node dissection (PLND) performed during robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer. We aimed to determine the frequency of pelvic lymph node metastasis and oncological outcomes following RALP with PLND in patients who did not receive adjuvant androgen deprivation therapy (ADT).
We retrospectively reviewed the records of 1740 consecutive patients who underwent RALP and extended PLND. The primary endpoint was biochemical recurrence (BCR). The estimated BCR probability was obtained using the Kaplan–Meier method. Cox proportional hazard regression models were used to assess for predictors of BCR.
One hundred and eight patients (6 %) with positive LNs were identified. The median number of LNs removed was 17 (IQR 11–24), and median follow-up was 26 months (IQR 14–43). Ninety-one (84 %) patients did not receive adjuvant ADT of whom 60 % had BCR with a median time to recurrence of 8 months. The 1- and 3-year BCR-free probability was 42 and 28 %, respectively. Patients with ≤2 LN+ had significantly better biochemical-free estimated probability compared to those with >2 LN+ (p = 0.002). The total number of LN+ (HR = 1.1; 95 % CI 1.01–1.2, p = 0.04) and Gleason 8–10 (HR = 1.96; 95 % CI 1.1–3.4, p = 0.02) were predictors of BCR on multivariate analysis.
Among men with positive lymph nodes at time of robotic prostatectomy, those with two or fewer positive nodes and Gleason <8 exhibited favorable biochemical-free survival without adjuvant therapy.
KeywordsProstate cancer Radical prostatectomy Biochemical recurrence Lymph node dissection Robotics
Robot-assisted laparoscopic prostatectomy
Pelvic lymph node dissection
Androgen deprivation therapy
Conflict of interest
The authors declare that they have no conflict of interest.
The manuscript entitled “Robotic-assisted pelvic lymph node dissection for prostate cancer: frequency of nodal metastases and oncological outcomes” was an investigation approved by the Internal Board Review committee of the University of Chicago (IRB number #13-031). Therefore, the manuscript has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. In addition, all patients gave their informed consent prior to their inclusion in the study.
- 20.Edge SB, Byrd DR, Compton CC (2010) AJCC cancer staging manual. Springer, New YorkGoogle Scholar
- 21.Briganti A, Karnes JR, Da Pozzo LF et al (2009) Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N+ patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy. Eur Urol 55:261–270CrossRefPubMedGoogle Scholar