title: Intraoperative finding of gross lymph node metastasis during robot-assisted prostatectomy.
abstract: Discovery of macroscopically positive lymph nodes (LN) during radical prostatectomy for clinically localized prostate cancer (PCa) is a rare event. We describe our experience of intraoperative finding of grossly positive LN during radical prostatectomy and evaluate outcomes and predictors. A total of 4,480 patients underwent robot-assisted radical prostatectomy (RARP) for clinically localized PCa from 2001 to 2010, and pelvic LN dissection was performed in 4,090 of these patients (91.3%). Patients with macroscopically positive LN discovered and confirmed intraoperatively were assessed, as was surgical decision (abort versus continue RARP). Patients with macroscopic LN-positive disease were also evaluated and oncologic outcomes were compared with patients with microscopic LN-positive disease on final pathology. LN-positive disease was found at final pathology in 87 patients (2.1%), of whom 13 (14.9%) had grossly abnormal LN confirmed intraoperatively by frozen section. RARP was aborted in nine cases and completed in four patients. All patients received adjuvant therapy with hormonal deprivation and/or radiation. Two patients in the aborted RARP subset died of PCa. All patients who underwent completion RARP are still alive at a mean follow-up of 57.2 months with one patient still alive at 95 months. Patients with macroscopically positive LN had a higher median preoperative prostate serum antigen (PSA) (17.2 vs. 6.7 μg/L, P = 0.002) and were more likely have biopsy perineural invasion (77.8 vs. 32.4%, P = 0.012). Intraoperative findings of macroscopically positive LN during RARP is a rare event that may occur in high-risk patients, particularly in those with a high PSA and biopsy perineural invasion. Long-term survival is possible after completion RARP.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA.
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA.
authors.forename: Firas
authors.initials: F
authors.lastname: Petros
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA. crogers2@hfhs.org.
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
keywords: Lymph nodes; Prostate cancer; Radical prostatectomy; Robotics