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Extended pelvic lymph node dissection during robotic prostatectomy: antegrade versus retrograde technique
Giancarlo Albo1,2, Andrea Gallioli3,4, Francesco Ripa3,5
1Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. albo.giancarlo@gmail.com.
BMC Urology
|March 22, 2024
Summary
Robot-assisted radical prostatectomy with extended pelvic lymphadenectomy (ePLND) can be performed antegrade or retrograde. Both methods yield similar surgical and oncologic outcomes, highlighting the importance of standardizing this prostate cancer procedure.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- Robot-assisted radical prostatectomy (RARP) with extended pelvic lymphadenectomy (ePLND) is a standard treatment for prostate cancer (PCa).
- Standardization of en-bloc ePLND techniques is lacking.
- This study compares antegrade and retrograde en-bloc ePLND approaches.
Purpose of the Study:
- To describe standardized antegrade and retrograde en-bloc ePLND techniques.
- To compare the surgical and oncological outcomes of these two approaches.
- To evaluate surgeon satisfaction with each technique.
Main Methods:
- Retrospective analysis of 105 patients undergoing RARP with en-bloc ePLND by a single surgeon.
- Patients were divided into antegrade (Group A) and retrograde (Group R) ePLND groups.
- Data collected included demographics, surgical details, complications, and surgeon-reported efficiency.
Main Results:
- No significant differences in lymph node yield, operative time, or complications between antegrade and retrograde ePLND.
- Antegrade ePLND had a higher rate of clinically significant lymphoceles (7.3% vs 1.6%).
- Antegrade ePLND was rated as "efficient" more often by the surgeon (80.5% vs 44%).
Conclusions:
- Antegrade and retrograde en-bloc ePLND demonstrate comparable surgical and oncological outcomes.
- Standardization of the procedure is more critical than the direction of dissection.
- The antegrade approach may be perceived as safer due to early identification of anatomical landmarks.
