Robotic­assisted pelvic lymph node dissection for prostate cancer: frequency of nodal metastases and oncological outcomes

ABSTRACT

Purpose Limited data are available regarding the oncologic efficacy of pelvic lymph node dissection (PLND) performed during robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer. We aimed to determine the frequency of pelvic lymph node metastasis and oncological outcomes following RALP with PLND in patients who did not receive adjuvant androgen deprivation therapy (ADT). Methods We retrospectively reviewed the records of 1740 consecutive patients who underwent RALP and extended PLND. The primary endpoint was biochemical recurrence (BCR). The estimated BCR probability was obtained using the Kaplan­Meier method. Cox proportional hazard regression models were used to assess for predictors of BCR. Results One hundred and eight patients (6 pertcent) with positive LNs were identified. The median number of LNs removed was 17 (IQR 11­24), and median follow-up was 26 months (IQR 14­43). Ninety-one (84 pertcent) patients did not receive adjuvant ADT of whom 60 pertcent had BCR with a median time to recurrence of 8 months. The 1- and 3-year BCR-free probability was 42 and 28 pertcent, respectively. Patients with ≤2 LN+ had significantly better biochemicalfree estimated probability compared to those with >2 LN+ (p = 0.002). The total number of LN+ (HR = 1.1; 95 pertcent CI 1.01­1.2, p = 0.04) and Gleason 8­10 (HR = 1.96; 95 perrtcent CI 1.1­3.4, p = 0.02) were predictors of BCR on multivariate analysis. Conclusion Among men with positive lymph nodes at time of robotic prostatectomy, those with two or fewer positive nodes and Gleason <8 exhibited favorable biochemical-free survival without adjuvant therapy.(AU) Cerrar