title: Robotic salvage retroperitoneal and pelvic lymph node dissection for 'node-only' recurrent prostate cancer: technique and initial series.
abstract: To describe the technique of robot-assisted high-extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for 'node-only' recurrent prostate cancer.
  
  
  
  In all, 10 patients underwent robot-assisted sRPLND+PLND (09/2015-03/2016) for 'node-only' recurrent prostate cancer, as identified by11C-acetate positron emission tomography/computed tomography imaging. Our anatomical template extends from bilateral renal artery/vein cranially up to Cloquet's node caudally, completely excising lymphatic-fatty tissue from aorto-caval and iliac vascular trees; RPLND precedes PLND. Meticulous node-mapping assessed nodes at four prospectively assigned anatomical zones.
  
  
  
  The median operative time was 4.8 h, estimated blood loss 100 mL and hospital stay 1 day. No patient had an intraoperative complication, open conversion or blood transfusion. Three patients had spontaneously resolving Clavien-Dindo grade II postoperative complications. The mean (range) number of nodes excised per patient was 83 (41-132) and mean (range) number of positive nodes per patient was 23 (0-109). Seven patients (70%) had positive nodes on final pathology. Node-positive rates per anatomical level I, II, III and IV were 28%, 32%, 33% and 33%, respectively. In patients with positive nodes, the median PSA level had decreased by 83% at the 2-month follow-up.
  
  
  
  The initial series of robot-assisted sRPLND+PLND is presented, wherein we duplicate open surgery with superior nodal counts and decreased morbidity. Robot-assisted technical details for an anatomical LND template up to the renal vessels are presented. Longer follow-up is necessary to assess oncological outcomes.
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: Abreu
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.|Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Carlos
authors.initials: C
authors.lastname: Fay
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Park
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Quinn
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Dorff
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Carpten
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kuhn
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: Parkash
authors.initials: P
authors.lastname: Gill
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Almeida
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: Inderbir
authors.initials: I
authors.lastname: Gill
mesh_terms: D000368:Aged; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011471:Prostatic Neoplasms / Q000473:pathology*; D012008:Recurrence; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*
keywords: #PCSM; #ProstateCancer; robot-assisted surgery; salvage PLND; salvage RPLND