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World Journal of Urology

, Volume 33, Issue 11, pp 1689–1694 | Cite as

Robotic-assisted pelvic lymph node dissection for prostate cancer: frequency of nodal metastases and oncological outcomes

  • Rodrigo A. LedezmaEmail author
  • Edris Negron
  • Aria A. Razmaria
  • Pankaj Dangle
  • Scott E. Eggener
  • Arieh L. Shalhav
  • Gregory P. Zagaja
Original Article

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusion

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.

Keywords

Prostate cancer Radical prostatectomy Biochemical recurrence Lymph node dissection Robotics 

Abbreviations

PCa

Prostate cancer

RALP

Robot-assisted laparoscopic prostatectomy

PLND

Pelvic lymph node dissection

LN

Lymph node

ADT

Androgen deprivation therapy

BCR

Biochemical recurrence

HR

Hazard ratio

SD

Standard deviation

CI

Confidence interval

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

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.

Supplementary material

345_2015_1515_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 28 kb)
345_2015_1515_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 15 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Rodrigo A. Ledezma
    • 1
    Email author
  • Edris Negron
    • 1
  • Aria A. Razmaria
    • 1
  • Pankaj Dangle
    • 1
  • Scott E. Eggener
    • 1
  • Arieh L. Shalhav
    • 1
  • Gregory P. Zagaja
    • 1
  1. 1.Section of Urology, Department of SurgeryUniversity of Chicago Medical CenterChicagoUSA

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