To describe the technique of robotic high-extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for 'node-only' recurrent prostate cancer.
Ten patients underwent robotic sRPLND+PLND (09/2015-03/2016) for 'node-only' recurrent prostate cancer, as identified by carbon-11 acetate PET/CT imaging. Our anatomic 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 4 prospectively-assigned anatomic zones.
Median operative time was 4.8 hours, blood loss 100 ml and hospital stay 1 day. No patient had intra-operative complication, open conversion or blood transfusion. Three patients had spontaneously-resolving Clavien II post-operative complications. Mean number of nodes excised per patient was 83 (41-132) and mean number of positive nodes per patient was 23 (0-109). Seven patients (70%) had positive nodes on final pathology. Node-positive rates per anatomic levels I, II, III and IV were 28%, 32%, 33% and 33%, respectively. In patients with positive nodes, median PSA decreased by 83% at 2 months follow-up.
The initial series of robotic sRPLND+PLND is presented, wherein we duplicate open surgery with superior nodal counts and decreased morbidity. Robotic technical details for an anatomic lymphadenectomy template up to the renal vessels is presented. Longer follow-up is necessary to assess oncologic outcomes. This article is protected by copyright. All rights reserved.
BJU international. 2016 Dec 15 [Epub ahead of print]
Andre Luis de Castro Abreu, Carlos E S Fay, Daniel Park, David Quinn, Tanya Dorff, John Carpten, Peter Kuhn, Parkash Gill, Fabio Almeida, Inderbir S Gill
USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California and Phoenix Imaging Center, Phoenix, Arizona.