title: Contemporary minimally-invasive extended pelvic lymph node dissection for prostate cancer before curative radiotherapy: prospective standardized analysis of complications.
abstract: OBJECTIVE
  To prospectively assess contemporary complication rates of minimally-invasive staging pelvic lymph node dissection before curative radiotherapy for prostate cancer using a standardized classification.
  
  
  METHODS
  A total of 100 prostate cancer patients underwent laparoscopic or robot-assisted pelvic lymph node dissection (95% extended). Surgical outcomes were compared with those of 43 patients undergoing open pelvic lymph node dissection (33% extended). Complications were recorded prospectively during hospitalization and follow-up visits, and graded using Clavien-Dindo classification. Lymphocele size was measured on postoperative magnetic resonance imaging or computed tomography.
  
  
  RESULTS
  Of the complications recorded, 10% were grade 1, 3% were grade 2 and 6% were grade 3. No grade 4-5 complications occurred. Compared with open pelvic lymph node dissection, minimally-invasive pelvic lymph node dissection was associated with less blood loss (P = 0.001) and shorter hospital stay (median 3 vs 6 days; P < 0.001), but longer operation time (130 vs 98 min; P < 0.001). The complication rate was similar in both groups. For the entire cohort, overall and symptomatic lymphoceles were seen in 91 (64%) and 18 patients (13%), respectively. On multivariate logistic regression, minimally-invasive surgery was the only independent predictor for lymphocele development (odds ratio 3.99; P = 0.015).
  
  
  CONCLUSIONS
  Minimally-invasive extended pelvic lymph node dissection before curative radiotherapy is associated with low morbidity. Asymptomatic lymphocele development rate is higher compared with open pelvic lymph node dissection.
authors: Department of Urology, Ghent University Hospital, Ghent, Belgium.
authors: Charles
authors: C
authors: Van Praet
authors: Karel
authors: K
authors: Decaestecker
authors: Valérie
authors: V
authors: Fonteyne
authors: Piet
authors: P
authors: Ost
authors: Pieter
authors: P
authors: De Visschere
authors: Stephanie
authors: S
authors: Verschuere
authors: Sylvie
authors: S
authors: Rottey
authors: Nicolaas
authors: N
authors: Lumen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology; D008210:Lymphocele / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D009367:Neoplasm Staging; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*
keywords: laparoscopy; lymph node excision; lymph nodes; prostatic neoplasms; robotics