Robot-assisted extended pelvic lymph node dissection in prostate cancer. When and how?

Area of Science:

• Urology
• Oncology
• Robotic Surgery

Background:

• Prostate cancer (PCa) management often involves radical prostatectomy.
• Pelvic lymph node dissection (PLND) is crucial for staging and treatment.
• Robot-assisted radical prostatectomy (RARP) is a common surgical approach.

Purpose of the Study:

• To review literature on extended pelvic lymph node dissection (ePLND) during RARP for PCa.
• To identify preoperative factors predicting lymph node metastases (LNM).
• To present the technique and outcomes of robotic ePLND.

Main Methods:

• Literature search of Medline/PubMed up to August 2018.
• Inclusion of comparative studies on PLND extent, oncologic outcomes, and complications.
• Complementary search for studies on diagnostic imaging and LNM predictors.

Main Results:

• No imaging technique reliably selects patients for PLND; decisions based on validated nomograms.
• Robot-assisted ePLND yields 5-21 lymph nodes, with positivity rates up to 37% based on risk.
• Robotic ePLND offers comparable lymph node yield and safety to open surgery.

Conclusions:

• ePLND is recommended for intermediate and high-risk PCa patients undergoing RARP.
• Oncologic outcome benefits of ePLND require further establishment.
• Robot-assisted approach provides shorter hospital stays, fewer transfusions, and comparable outcomes.