Robot-assisted Salvage Lymph Node Dissection for Clinically Recurrent Prostate Cancer.
Salvage lymph node dissection has been described as a feasible treatment for the management of prostate cancer patients with nodal recurrence after primary treatment.



To report perioperative, pathologic, and oncologic outcomes of robot-assisted salvage nodal dissection (RASND) in patients with nodal recurrence after radical prostatectomy (RP).



We retrospectively evaluated 16 patients affected by nodal recurrence following RP documented by positive positron emission tomography/computed tomography scan.



Surgery was performed using DaVinci Si and Xi systems. A pelvic nodal dissection that included lymphatic stations overlying the external, internal, and common iliac vessels, the obturator fossa, and the presacral nodes was performed. In 13 (81.3%) patients a retroperitoneal lymph node dissection that included all nodal tissue located between the aortic bifurcation and the renal vessels was performed.



Perioperative outcomes consisted of operative time, blood loss, length of hospital stay, and complications occurred within 30 d after surgery. Biochemical response (BR) was defined as a prostate-specific antigen level <0.2 ng/ml at 40 d after RASND.



Median operative time, blood loss, and length of hospital stay were 210min, 250ml, and 3.5 d. The median number of nodes removed was 16.5. Positive lymph nodes were detected in 11 (68.8%) patients. Overall, four (25.0%) and five (31.2%) patients experienced intraoperative and postoperative complications, respectively. Overall, one (6.3%) and four (25.0%) patients had Clavien I and II complications within 30 d after RASND, respectively. Overall, five (33.3%) patients experienced BR after surgery. Our study is limited by the small cohort of patients evaluated and by the follow-up duration.



RASND represents a feasible procedure in patients with nodal recurrence after RP and provides acceptable short-term oncologic outcomes, where one out of three patients experience BR immediately after surgery. Long-term data are needed to confirm the effectiveness of this approach.



We report our initial experience with robot-assisted salvage nodal dissection for the management of patients with lymph node recurrence after radical prostatectomy. This technique represents a feasible and effective approach, where no high-grade complications were recorded and one out of three patients experienced biochemical response at 40 d after surgery.
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Francesco
F
Montorsi
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium. Electronic address: giorgio.gandaglia@gmail.com.
Giorgio
G
Gandaglia
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
Nicola
N
Fossati
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Nazareno
N
Suardi
OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Cristian
C
Pultrone
OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
Ruben
R
De Groote
OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
Zach
Z
Dovey
OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
Paolo
P
Umari
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Andrea
A
Gallina
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Alberto
A
Briganti
OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
Alexandre
A
Mottrie
D000368:Aged; D016063:Blood Loss, Surgical; D005060:Europe; D005240:Feasibility Studies; D061847:Hospitals, High-Volume; D006801:Humans; D007610:Kallikreins / Q000097:blood; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D000072078:Positron Emission Tomography Computed Tomography; D011183:Postoperative Complications / Q000209:etiology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
Locally Advanced; Prostate Cancer; Radical Prostatectomy; Robot-assisted; Salvage Lymph Node Dissection