Comparison of lymph node yield in robot-assisted laparoscopic prostatectomy with that in open radical retropubic prostatectomy.
OBJECTIVE
• To investigate both the feasibility and the adequacy of pelvic lymph node dissection (PLND) during robot-assisted laparoscopic prostatectomy (RALP) by comparing lymph node yields obtained during RALP with those obtained during traditional open retropubic radical prostatectomy (RRP).


METHODS
• We retrospectively reviewed 1047 patients who underwent radical prostatectomy between 2001 and 2009. • In all, 626 patients underwent RALP while 421 patients had traditional open RRP. All patients undergoing bilateral PLND were included in our analysis. • Lymph node yields and lymph node involvement for each surgical approach were calculated and examined. • PLND-related complications were analysed.


RESULTS
• Of the 1047 patients, 816 patients underwent bilateral PLND of whom 473 underwent RALP, while 343 underwent RRP. The mean lymph node yields for the RALP cohort (7.1, interquartile range 4-10) was significantly higher (P < 0.001) than for the RRP cohort (6.0, interquartile range 3-8). • The percentage of patients with nodal involvement was 1.1 for RALP and 2.3 for RRP (P= 0.167). • Mean age, preoperative PSA values, and pre- and postoperative Gleason scores were similar between the two cohorts. • PLND-related complications were similar between both cohorts.


CONCLUSIONS
• In patients undergoing RALP, PLND is feasible and provides lymph node yields comparable with those of the standard open approach. • PLND should be strongly considered in all radical prostatectomy patients when clinically indicated, regardless of surgical technique.
Lallas
Costas D
CD
Department of Urology and Department of Pathology, Anatomy and Cell Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA. costas.lallas@jefferson.edu
Pe
Mark L
ML
Thumar
Adeep B
AB
Chandrasekar
Thenappan
T
Lee
Franklin C
FC
McCue
Peter
P
Gomella
Leonard G
LG
Trabulsi
Edouard J
EJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012371:Robotics