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Robotic salvage retroperitoneal and pelvic lymph node dissection for 'node-only' recurrent prostate cancer: technique and initial series.

Authors
  • Abreu, Andre1
  • Fay, Carlos1, 2
  • Park, Daniel1
  • Quinn, David1
  • Dorff, Tanya1
  • Carpten, John1
  • Kuhn, Peter1
  • Gill, Parkash1
  • Almeida, Fabio1
  • Gill, Inderbir1
  • 1 University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA.
  • 2 Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. , (Brazil)
Type
Published Article
Journal
British Journal of Urology
Publisher
Wiley (Blackwell Publishing)
Publication Date
Sep 01, 2017
Volume
120
Issue
3
Pages
401–408
Identifiers
DOI: 10.1111/bju.13741
PMID: 27981731
Source
Medline
Keywords
Language
English
License
Unknown

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 by 11 C-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. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

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