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The ongoing dilemma in pelvic lymph node dissection during radical prostatectomy: who should decide and in which patients?

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Abstract

Pelvic lymph node dissection (pLND) is considered the most reliable method for the detection of lymph node metastases in prostate cancer. Current clinical guidelines recommend performing pLND in intermediate- and high-risk patients that are defined using different clinical nomograms and different cut-off values. Although the detection of lymph node metastatic disease can identify patients who could benefit from adjuvant therapies and potentially improve prostate cancer-related survival outcomes, so far there has been no level 1 evidence to support this survival benefit. Available retrospective data that suggest oncological benefits are subject to various forms of bias. Furthermore, pLND is not feasible or may be risky in some patient-related conditions, such as morbid obesity and previous history of intraabdominal surgery including organ transplants. In this review, we discuss the current controversies surrounding pLND during robotic-assisted prostatectomy in prostate cancer, specifically the pitfalls in interpretation of restricted evidence suggesting its oncological benefits, and examine the potential influence of patient- and surgeon-related factors that may determine the decision to perform pLND.

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  1. Advent Health Global Robotics Institute, 410 Celebration Place Suite#200, Celebration, 34747, FL, USA

    Fikret Fatih Onol, Seetharam Bhat, Marcio Moschovas, Travis Rogers & Vipul Patel

  2. Associated Medical Professional Urology, Syracuse, NY, USA

    David Albala

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  1. Fikret Fatih Onol
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  2. Seetharam Bhat
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Author Fikret F. Onol MD declares that he has no conflict of interest. Author Seetharam Bhat MD declares that he has no conflict of interest. Author Marcio Moschovas MD declares that he has no conflict of interest. Author Travis Rogers MD declares that he has no conflict of interest. Author David Albala MD declares that he has no conflict of interest. Author Vipul Patel MD declares that he has no conflict of interest.

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Onol, F.F., Bhat, S., Moschovas, M. et al. The ongoing dilemma in pelvic lymph node dissection during radical prostatectomy: who should decide and in which patients?. J Robotic Surg 14, 549–558 (2020). https://doi.org/10.1007/s11701-019-01041-x

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