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Comparison of the diagnostic efficacy and perioperative outcomes of limited versus extended pelvic lymphadenectomy during robot-assisted radical prostatectomy: a multi-institutional retrospective study in Japan

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Abstract

Background

We conducted a retrospective study to compare the perioperative course and lymph node (LN) counts of patients undergoing limited pelvic lymphadenectomy (lPLND) or extended pelvic lymphadenectomy (ePLND) during robot-assisted radical prostatectomy in an initial Japanese series.

Methods

The cohort included 1333 patients who underwent either lPLND (n = 902) or ePLND (n = 431) during robot-assisted radical prostatectomy at five institutions in Japan. All complications within 28 days of surgery were recorded, and clinical data were collected retrospectively. The outcomes and complications were compared relative to the extent of lymphadenectomy, and we conducted univariate and multivariate logistic regression analyses to assess the predictors of the major complications.

Results

On multivariate analysis for evaluating the associations between major complications and perioperative characteristics, console time (p = 0.001) was significantly associated with major complications, although the extent of lymphadenectomy (p = 0.272) was not significantly associated with major complications. In the distribution of positive LNs removed in the extended pelvic lymphadenectomy cohort, 60.4% of patients had positive LNs only in the obturator/internal iliac region. However, 22.6% of the patients with positive LNs had no positive LNs in the obturator/internal iliac region, but only in the external/common iliac region.

Conclusions

ePLND, which significantly increased the console time and blood loss but nearly quadrupled the lymph node yield, is considered a relatively safe and acceptable procedure. Moreover, the results of this study suggest that ePLND improves staging and removes a greater number of metastatic nodes.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1 Nishi, Yonago, Tottori, 683-8503, Japan

    Shuichi Morizane, Masashi Honda & Atsushi Takenaka

  2. Department of Urology, Chiba Cancer Center, Chiba, Japan

    Satoshi Fukasawa & Atsushi Komaru

  3. Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Junichi Inokuchi & Masatoshi Eto

  4. Department of Urology, St. Luke’s International Hospital, Tokyo, Japan

    Masaki Shimbo & Kazunori Hattori

  5. Department of Urology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

    Yoshiaki Kawano

Authors
  1. Shuichi Morizane
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  2. Masashi Honda
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  3. Satoshi Fukasawa
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  4. Atsushi Komaru
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  5. Junichi Inokuchi
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  6. Masatoshi Eto
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  7. Masaki Shimbo
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  8. Kazunori Hattori
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  9. Yoshiaki Kawano
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  10. Atsushi Takenaka
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Corresponding author

Correspondence to Masashi Honda.

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Morizane, S., Honda, M., Fukasawa, S. et al. Comparison of the diagnostic efficacy and perioperative outcomes of limited versus extended pelvic lymphadenectomy during robot-assisted radical prostatectomy: a multi-institutional retrospective study in Japan. Int J Clin Oncol 23, 568–575 (2018). https://doi.org/10.1007/s10147-017-1223-x

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  • DOI: https://doi.org/10.1007/s10147-017-1223-x

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