Reevaluating the Therapeutic Role of Pelvic Lymph Node Dissection in Robot-Assisted Radical Prostatectomy

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Extended pelvic lymph node dissection (PLND) is recommended for intermediate- and high-risk prostate cancer staging.
• The therapeutic benefit of PLND in prostate cancer remains unproven.
• This study evaluates the therapeutic significance of PLND during robot-assisted radical prostatectomy (RARP).

Purpose of the Study:

• To assess the therapeutic impact of extended PLND in patients with intermediate- and high-risk prostate cancer undergoing RARP.
• To compare oncological outcomes (PSA-PFS, OS) between patients with and without PLND.
• To evaluate perioperative outcomes associated with PLND.

Main Methods:

• Retrospective analysis of 313 patients with intermediate- or high-risk prostate cancer undergoing RARP.
• Comparison between a no-PLND group and an extended-PLND group.
• Propensity score matching used to create 85 matched pairs for analysis of PSA-PFS and OS.

Main Results:

• No significant difference in prostate-specific antigen progression-free survival (PSA-PFS) or overall survival (OS) between extended-PLND and no-PLND groups.
• The no-PLND group showed significantly lower complication rates and shorter console times.
• No high-grade (Clavien-Dindo Grade 3-4) complications occurred in the no-PLND group.

Conclusions:

• Extended PLND during RARP for intermediate- and high-risk prostate cancer provides minimal therapeutic benefit.
• The procedure did not improve oncological outcomes (PSA-PFS, OS).
• Performing PLND was associated with increased complications and operative time.