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

Ryosuke Yamase1, Satoshi Yamamoto2, Koki Watanabe2

  • 1Department of Division of Systems Medicine and Gene Therapy Research Center for Genomic Medicine, Saitama Medical University, Saitama, Japan.

Asian Journal of Endoscopic Surgery
|April 14, 2025
PubMed
Summary

Extended pelvic lymph node dissection (PLND) in robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer offers no survival benefit. This procedure did not improve progression-free or overall survival and increased complications.

Keywords:
RARPbiochemical PSA recurrencelymph node dissectionprostate cancer

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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.