The following is a summary of “Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate Cancer,” published in the January 2024 issue of Urology by Sigg et al.

Extended pelvic lymph node dissection (ePLND) is a common procedure during robot-assisted laparoscopic radical prostatectomy (RARP) in men. Yet, there needs to be more knowledge regarding site-specific yields and metastatic patterns. In this retrospective study, data from 1,107 patients who underwent RARP between 2004 and 2018 were analyzed to explore anatomical site-specific outcomes of ePLND. The procedure involved the removal and separate analysis of internal, external, and obturator nodes. The analysis included assessing lymph node (LN) yields, metastatic patterns, complications, and the oncological outcomes in patients diagnosed with positive nodes (pN+), such as postoperative PSA persistence and survival.

Among the investigated cohort that underwent 823 ePLNDs, 98 men were diagnosed as pN+ (8.9%). The median LN yield was 19 (14–25), with 10 (7–13) on the right and 9 (6–12) on the left side (P < 0.001). Notably, more metastatic LNs were found on the right side compared to the left (41 vs. 19). LNs were retrieved from specific anatomical zones, with a median of six from the external, three from the internal iliac artery, and eight from the obturator fossa. Symptomatic lymphoceles occurred exclusively in the ePLND group (2.3% vs. 0%, p = 0.04). Postoperatively, 47.9% of pN+ men reached a < 0.1 μg/ml PSA. No significant association was observed between a specific pN+ region and postoperative PSA persistence or biochemical recurrence-free survival. The estimated cancer-specific survival rate at 5 years was 98.5% for pN+ disease.

The study suggests that robot-assisted laparoscopic ePLND can achieve a high LN yield with a low complication rate. However, an observed imbalance in removed and positive LNs between the right and left sides raises considerations. Despite a notable rate of postoperative PSA persistence and early recurrence in pN+ patients, their overall survival remains excellent, prompting further evaluation of the therapeutical value of ePLND in cases of already spread disease.

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01409-8