Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate Cancer
Abstract Introduction Extended pelvic lymph node dissection (ePLND) in men undergoing robot-assisted laparoscopic radical prostatectomy (RARP) is a widely used procedure. However, little is known about anatomical site-specific yields and subsequent metastatic patterns in these patients. Patients and...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Urology |
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| Online Access: | https://doi.org/10.1186/s12894-024-01409-8 |
| _version_ | 1797273106227658752 |
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| author | Silvan Sigg Fabienne Lehner Etienne Xavier Keller Karim Saba Holger Moch Tullio Sulser Daniel Eberli Ashkan Mortezavi |
| author_facet | Silvan Sigg Fabienne Lehner Etienne Xavier Keller Karim Saba Holger Moch Tullio Sulser Daniel Eberli Ashkan Mortezavi |
| author_sort | Silvan Sigg |
| collection | DOAJ |
| description | Abstract Introduction Extended pelvic lymph node dissection (ePLND) in men undergoing robot-assisted laparoscopic radical prostatectomy (RARP) is a widely used procedure. However, little is known about anatomical site-specific yields and subsequent metastatic patterns in these patients. Patients and methods Data on a consecutive series of 1107 patients undergoing RARP at our centre between 2004 and 2018 were analysed. In men undergoing LN dissection, the internal, external and obturator nodes were removed and sent in separately. We performed an analysis of LN yields in total and for each anatomical zone, patterns of LN metastases and complications. Oncological outcome in pN+ disease was assessed including postoperative PSA persistence and survival. Results A total of 823 ePLNDs were performed in the investigated cohort resulting in 98 men being diagnosed as pN+ (8.9%). The median (IQR) LN yield was 19 (14–25), 10 (7–13) on the right and 9 (6–12) on the left side (P < 0.001). A median of six (4–8) LNs were retrieved from the external, three (1–6) from the internal iliac artery, and eight (6–12) from the obturator fossa. More men had metastatic LNs on the right side compared to the left (41 vs. 19). Symptomatic lymphoceles occurred exclusively in the ePLND group (2.3% vs. 0%, p = 0.04). Postoperatively, 47 (47.9%) of men with pN+ reached a PSA of < 0.1μg/ml. There was no association between a certain pN+ region and postoperative PSA persistence or BCRFS. The estimated cancer specific survival rate at 5 years was 98.5% for pN+ disease. Conclusion Robot-assisted laparoscopic ePLND with a high LN yield and low complication rate is feasible. However, we observed an imbalance in more removed and positive LNs on the right side compared to the left. A high rate of postoperative PSA persistence and early recurrence in pN+ patients might indicate a possibly limited therapeutical value of the procedure in already spread disease. Yet, these men demonstrated an excellent survival. |
| first_indexed | 2024-03-07T14:38:50Z |
| format | Article |
| id | doaj.art-739e11d3bfba408ea2ea7695a1baf8cc |
| institution | Directory Open Access Journal |
| issn | 1471-2490 |
| language | English |
| last_indexed | 2024-03-07T14:38:50Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Urology |
| spelling | doaj.art-739e11d3bfba408ea2ea7695a1baf8cc2024-03-05T20:28:34ZengBMCBMC Urology1471-24902024-01-0124111010.1186/s12894-024-01409-8Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate CancerSilvan Sigg0Fabienne Lehner1Etienne Xavier Keller2Karim Saba3Holger Moch4Tullio Sulser5Daniel Eberli6Ashkan Mortezavi7Department of Urology, University Hospital Zurich, University of ZurichDepartment of Urology, University Hospital Zurich, University of ZurichDepartment of Urology, University Hospital Zurich, University of ZurichUrologiezentrum Hirslanden, Hirslanden Klinik AarauDepartment of Pathology and Molecular Pathology, University Hospital ZurichDepartment of Urology, University Hospital Basel, University of BaselDepartment of Urology, University Hospital Zurich, University of ZurichDepartment of Urology, University Hospital Zurich, University of ZurichAbstract Introduction Extended pelvic lymph node dissection (ePLND) in men undergoing robot-assisted laparoscopic radical prostatectomy (RARP) is a widely used procedure. However, little is known about anatomical site-specific yields and subsequent metastatic patterns in these patients. Patients and methods Data on a consecutive series of 1107 patients undergoing RARP at our centre between 2004 and 2018 were analysed. In men undergoing LN dissection, the internal, external and obturator nodes were removed and sent in separately. We performed an analysis of LN yields in total and for each anatomical zone, patterns of LN metastases and complications. Oncological outcome in pN+ disease was assessed including postoperative PSA persistence and survival. Results A total of 823 ePLNDs were performed in the investigated cohort resulting in 98 men being diagnosed as pN+ (8.9%). The median (IQR) LN yield was 19 (14–25), 10 (7–13) on the right and 9 (6–12) on the left side (P < 0.001). A median of six (4–8) LNs were retrieved from the external, three (1–6) from the internal iliac artery, and eight (6–12) from the obturator fossa. More men had metastatic LNs on the right side compared to the left (41 vs. 19). Symptomatic lymphoceles occurred exclusively in the ePLND group (2.3% vs. 0%, p = 0.04). Postoperatively, 47 (47.9%) of men with pN+ reached a PSA of < 0.1μg/ml. There was no association between a certain pN+ region and postoperative PSA persistence or BCRFS. The estimated cancer specific survival rate at 5 years was 98.5% for pN+ disease. Conclusion Robot-assisted laparoscopic ePLND with a high LN yield and low complication rate is feasible. However, we observed an imbalance in more removed and positive LNs on the right side compared to the left. A high rate of postoperative PSA persistence and early recurrence in pN+ patients might indicate a possibly limited therapeutical value of the procedure in already spread disease. Yet, these men demonstrated an excellent survival.https://doi.org/10.1186/s12894-024-01409-8OutcomeLymph node dissectionProstate cancerLaparoscopicRoboticda Vinci |
| spellingShingle | Silvan Sigg Fabienne Lehner Etienne Xavier Keller Karim Saba Holger Moch Tullio Sulser Daniel Eberli Ashkan Mortezavi Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate Cancer BMC Urology Outcome Lymph node dissection Prostate cancer Laparoscopic Robotic da Vinci |
| title | Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate Cancer |
| title_full | Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate Cancer |
| title_fullStr | Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate Cancer |
| title_full_unstemmed | Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate Cancer |
| title_short | Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate Cancer |
| title_sort | outcomes of robot assisted laparoscopic extended pelvic lymph node dissection for prostate cancer |
| topic | Outcome Lymph node dissection Prostate cancer Laparoscopic Robotic da Vinci |
| url | https://doi.org/10.1186/s12894-024-01409-8 |
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