title: Outcomes and complications of pelvic lymph node dissection during robotic-assisted radical prostatectomy.
abstract: OBJECTIVE
  Describe the outcomes and complications of patients who underwent standard pelvic lymphadenectomy (SPLND) and extended PLND (EPLND), or who did not undergo PLND (non-PLND) at the time of robotic-assisted laparoscopic radical prostatectomy (RALP).
  
  
  METHODS
  Retrospective analysis of prospectively collected longitudinal data of 492 RALPs performed by a single surgeon (Kane) over a 5-year period. Patients are subdivided into three treatment groups: 54 EPLND; 231 SPLND; and 207 non-PLND. Indications for EPLND include Gleason score ≥ 8, PSA ≥ 10 ng/mL, and higher D'Amico risk group. Patient demographics, perioperative complications, and short-term oncologic outcomes are compared.
  
  
  RESULTS
  Patients who underwent EPLND had higher-risk prostate cancer as evidenced by higher mean PSA (8.5 ng/mL), biopsy Gleason sum (≥ 8) (57.7 %), and D'Amico risk group (75.9 %), compared to SPLND and/or non-PLND groups (p ≤ 0.001). The EPLND total lymph node yield was similar compared to SPLND (20 vs. 18; p = 0.070). When the EPLND (n = 41) and SPLND (n = 57) were examined among only high-risk patients, the lymph node (IQR) yields [20 (14-29) vs. 17 (12-23)] and the proportion of positive nodes [29.3 % (12/41) vs. 12.3 % (7/57)] differed significantly (p = 0.048 and p = 0.042, respectively). Complication rates for all groups were similar and lymphocele formation was 5 %; 2.5 % were clinically significant.
  
  
  CONCLUSIONS
  Robotic PLND can be performed with nodal yield comparable to open or laparoscopic PLND. Robotic EPLND improves nodal yield and the proportion of high-risk patients with nodal metastases recognized. Robotic PLND is associated with an approximately 5 % lymphocele rate. There is no difference in complications between EPLND and SPLND.
authors.affiliation: Division of Urology, Department of Surgery, UC San Diego Health System, 200 West Arbor Drive #8897, San Diego, CA 92103-8897, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
authors.forename: Ramzi
authors.initials: R
authors.lastname: Jabaji
authors.forename: Omer A
authors.initials: OA
authors.lastname: Raheem
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
mesh_terms: D000368:Aged; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology; D008210:Lymphocele / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome