title: The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in the management of high-risk prostate cancer: a systematic review.
abstract: BACKGROUND
  The role of robot-assisted radical prostatectomy (RARP) for men with high-risk (HR) prostate cancer (PCa) has not been well studied.
  
  
  OBJECTIVE
  To evaluate the indications for surgical treatment, technical aspects such as nerve sparing (NS) and lymph node dissection (LND), and perioperative outcomes of men with HR PCa treated with RARP.
  
  
  METHODS
  A systematic expert review of the literature was performed in October 2012, searching the Medline, Web of Science, and Scopus databases. Studies with a precise HR definition, robotic focus, and reporting of perioperative and pathologic outcomes were included.
  
  
  RESULTS
  A total of 12 papers (1360 patients) evaluating RARP in HR PCa were retrieved. Most studies (67%) used the D'Amico classification for defining HR. Biopsy Gleason grade 8-10 was the most frequent HR identifier (61%). Length of follow-up ranged from 9.7 to 37.7 mo. Incidence of NS varied, although when performed did not appear to compromise oncologic outcomes. Extended LND (ELND) revealed positive nodes in up to a third of patients. The rate of symptomatic lymphocele after ELND was 3%. Overall mean operative time was 168 min, estimated blood loss was 189 ml, length of hospital stay was 3.2 d, and catheterization time was 7.8 d. The 12-mo continence rates using a no-pad definition ranged from 51% to 95% with potency recovery ranging from 52% to 60%. The rate of organ-confined disease was 35%, and the positive margin rate was 35%. Three-year biochemical recurrence-free survival ranged from 45% to 86%.
  
  
  CONCLUSIONS
  Although the use of RARP for HR PCa has been relatively limited, it appears safe and effective for select patients. Short-term results are similar to the literature on open radical prostatectomy. Variability exists for NS and the template of LND, although ELND improves staging and removes a higher number of metastatic nodes. Further study is required to assess long-term outcomes.
authors.affiliation: City of Hope Cancer Center, Duarte, CA, USA. Electronic address: byuh@coh.org.
authors.forename: Bertram
authors.initials: B
authors.lastname: Yuh
authors.affiliation: University Hospital of Verona, Verona, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.affiliation: University of Aachen, Aachen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Kimm
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: University of Padua, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Tewari
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Karim
authors.initials: K
authors.lastname: Touijer
authors.affiliation: City of Hope Cancer Center, Duarte, CA, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson
authors.affiliation: University of Montreal Hospital Center, Montreal, Canada.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.affiliation: University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis; D008210:Lymphocele / Q000209:etiology; D008297:Male; D018579:Patient Selection; D010388:Pelvis; D059348:Peripheral Nerve Injuries / Q000517:prevention & control; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012371:Robotics; D014549:Urinary Incontinence / Q000209:etiology
keywords: High risk; Lymph node dissection; Prostate cancer; Prostatectomy; Robotic