title: Extended pelvic lymph node dissection including internal iliac packet should be performed during robot-assisted laparoscopic radical prostatectomy for high-risk prostate cancer.
abstract: BACKGROUND
  The indication and anatomic limits of pelvic lymph node dissection (PLND) have not been clearly defined. Therefore, we assessed whether the extent of PLND at robot-assisted laparoscopic radical prostatectomy (RALP) had any benefit on lymph node yield, staging accuracy, and biochemical recurrence (BCR) in patients with high-risk prostate cancer.
  
  
  METHODS
  Between July 2005 and July 2010, a retrospective analysis was performed on 200 patients with high-risk prostate cancer stratified by D'Amico classification. The study population was divided into different groups: patients in Group 1 had standard PLND, and Group 2 had extended PLND (ePLND). The clinicopathologic findings of patients and surgical outcomes of PLND with each procedure were measured. Kaplan-Meier and log rank tests were used to estimate BCR-free survival rates. Univariate and multivariate survival analyses were done with the Cox proportional hazard regression model.
  
  
  RESULTS
  Medians of 15 (interquartile range, 11-19) and 24 (interquartile range, 18-28) lymph nodes were dissected in Groups 1 and 2, respectively (P<.001). The incidences of lymph node metastasis were 5.2% (8/155) in Group 1 and 22.2% (10/45) in Group 2. Regardless of the extent of PLND, the patients with positive lymph nodes had a significantly lower BCR-free survival than those with negative lymph nodes. Twenty-five percent (7/27) of positive lymph nodes were in the internal iliac packet and common iliac packet. In particular, of the positive internal iliac nodes, 75% (3/4) of nodes were found in that location, exclusively.
  
  
  CONCLUSIONS
  An ePLND that identifies patients with lymph node metastasis including the internal iliac packet during RALP provides an accurate pathologic staging and may have survival benefits in high-risk prostate cancer.
authors.affiliation: Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Jae Hung
authors.initials: JH
authors.lastname: Jung
authors.forename: Joo Wan
authors.initials: JW
authors.lastname: Seo
authors.forename: Meng Shi
authors.initials: MS
authors.lastname: Lim
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.forename: Jae Mann
authors.initials: JM
authors.lastname: Song
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
mesh_terms: D000368:Aged; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012371:Robotics