Robot-assisted Salvage Lymph Node Dissection for Clinically Recurrent Prostate Cancer.

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Salvage lymph node dissection is a potential management strategy for prostate cancer patients experiencing nodal recurrence following primary treatment.
• Nodal recurrence after radical prostatectomy (RP) presents a clinical challenge requiring effective treatment options.

Purpose of the Study:

• To evaluate the perioperative, pathologic, and oncologic outcomes of robot-assisted salvage nodal dissection (RASND) in patients with recurrent prostate cancer after RP.
• To assess the feasibility and efficacy of RASND in managing lymph node recurrence.

Main Methods:

• Retrospective evaluation of 16 patients with documented nodal recurrence after RP, confirmed by positron emission tomography/computed tomography scans.
• Surgical procedures were performed using DaVinci Si and Xi robotic systems, involving pelvic and, in most cases, retroperitoneal lymph node dissection.
• Outcomes measured included operative time, blood loss, hospital stay, complications, and biochemical response (prostate-specific antigen <0.2 ng/ml at 40 days post-surgery).

Main Results:

• The median operative time was 210 minutes, with a median blood loss of 250 ml and a median hospital stay of 3.5 days.
• A median of 16.5 lymph nodes were removed, with positive nodes found in 68.8% of patients.
• Biochemical response was observed in 33.3% of patients; 25% experienced complications within 30 days post-surgery, with no high-grade events recorded.

Conclusions:

• Robot-assisted salvage nodal dissection (RASND) is a feasible procedure for managing nodal recurrence after radical prostatectomy (RP).
• The technique demonstrates acceptable short-term oncologic outcomes, with a notable proportion of patients achieving biochemical response.
• Further long-term data are necessary to fully establish the effectiveness and durability of RASND.