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Robot assisted extended pelvic lymphadenectomy at radical cystectomy: lymph node yield compared with second look open
John W Davis1, Kris Gaston, Roosevelt Anderson
1Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. johndavis@mdanderson.org
The Journal of Urology
|November 16, 2010
Summary
Robot-assisted radical cystectomy achieves 93% of the lymph node yield compared to open surgery. This indicates that robot-assisted pelvic lymph node dissection is a complete and effective procedure for cancer staging.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- Robot-assisted radical cystectomy (RARC) offers potential patient recovery benefits.
- Assessing the completeness of pelvic lymph node dissection (PLND) in RARC is challenging based solely on lymph node counts.
- Extended PLND is crucial for accurate cancer staging and treatment planning.
Purpose of the Study:
- To determine the lymph node yield fraction of robot-assisted PLND compared to open surgery.
- To evaluate the completeness of extended robot-assisted PLND.
- To address concerns regarding the efficacy of RARC for lymph node dissection.
Main Methods:
- A prospective study involving 11 patients undergoing RARC with extended PLND.
- Robot-assisted PLND was followed by a 'second look' open PLND.
- Lymph nodes from both procedures were submitted separately for analysis.
Main Results:
- Robot-assisted PLND yielded a median of 43 lymph nodes, with a 'second look' yielding a median of 4 additional nodes.
- The overall yield for robot-assisted PLND was 93% compared to open surgery benchmarks.
- 67% of 'second look' dissections were clear of residual lymph node tissue.
Conclusions:
- Robot-assisted PLND achieves a high lymph node yield, comparable to open surgery.
- This study demonstrates the completeness of robot-assisted PLND, alleviating concerns about its efficacy.
- RARC with extended PLND is a feasible and effective oncological procedure.
