title: Lymph node dissection during robotic-assisted laparoscopic prostatectomy: comparison of lymph node yield and clinical outcomes when including common iliac nodes with standard template dissection.
abstract: OBJECTIVE
  To compare the perioperative outcomes of standard pelvic to full-template lymph node (LN) dissection (LND) during robotic-assisted laparoscopic prostatectomy (RALP).
  
  
  METHODS
  The study included 94 patients undergoing RALP with LND between January 2007 and August 2008, by one surgeon. In February 2008 the LND template was modified to include common iliac and medial hypogastric LNs. Clinical and pathological patient characteristics were analysed, including total number of retrieved and positive LNs in each area of dissection, operative duration and complications.
  
  
  RESULTS
  Of the 94 patients, 62 underwent standard LND (group 1) and 32 underwent full-template pelvic LND (group 2). The median (mean) number of LNs retrieved in groups 1 and 2 were 12 (13.3) and 17.5 (21.4), respectively. Of the five patients with positive LNs (5%), four were in group 2 (13%); two of these patients had positive LNs in the common iliac dissection, and for one of these patients it was the sole site of involvement. Deep venous thrombosis, pulmonary embolism or transient neuropraxia occurred in six patients (five in group 1 and one in group 2). The median additional operative time for resection of common and internal LNs was 25 min.
  
  
  CONCLUSIONS
  LN yield increased and additional sites of LN metastases were identified during full-template pelvic LND during RALP. This modification was not associated with an increased rate of complications. Derived benefits of including additional nodal dissection and the effect on staging accuracy remain to be determined.
authors.affiliation: Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. katzd@mskcc.org
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Katz
authors.forename: David S
authors.initials: DS
authors.lastname: Yee
authors.forename: Guilherme
authors.initials: G
authors.lastname: Godoy
authors.forename: Lucas
authors.initials: L
authors.lastname: Nogueira
authors.forename: Kian Tai
authors.initials: KT
authors.lastname: Chong
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Coleman
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome