Related Experiment Video
Updated: May 20, 2025
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
The effect of lymph node dissection on oncological outcomes in contemporary robotic salvage radical prostatectomy
Mike Wenzel1, Christoph Würnschimmel2, Marcio Covas Moschovas3
1Department of Urology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany. Mike.Wenzel@unimedizin-ffm.de.
Purpose:
Surgical features associated with better cancer-control outcomes are under investigation for salvage radical prostatectomy patients undergoing robotic approaches.
Methods:
The Junior ERUS/Young Academic Urologist Working Group in Robotics in Urology conducted a multicentric project to investigate the effect of lymph node dissection (LND) and pN stage on biochemical recurrence-free (BCR), metastases-free (MFS) and overall survival (OS) outcomes in 444 robotic salvage radical prostatectomy (s-RARP) patients.
Results:
Of all patients, 63% underwent LND with a median of eight removed lymph nodes. Patients without LND more frequently underwent initial focal therapy (60% vs. 37%) and harbored higher pathological Gleason score 8-10 (both p ≤ 0.02). In BCR analyses, no differences were observed between patients with vs. without LND with 24-months BCR-free survival rates of 74.8% vs. 73.6%. In OS analyses, better OS for LND patients (HR: 0,39, p = 0.049) was observed with 60-months OS rates of 81.3% vs. 92.1% for no LND vs. LND. Of LND patients. 16% harbored pN1 stage, which was associated with worse BCR-free survival (HR: 2.0,p = 0.025) with 60-months BCR-free survival rates of 63% for pN0 vs. 49.6% for pN1. In MFS analyses, no difference between both groups were observed. In OS analyses, the observed differences did not reach statistical significance with 60-months OS rates of 93.4% for pN0 vs. 84.7% for pN1.
Conclusion:
Rates of LND are relatively low in contemporary s-RARP patients and are more frequently performed in patients with worse characteristics. However, LND may be associated with better OS, while pN1 patients are associated with worse cancer-control outcomes.
Insights
Lymph node dissection (LND) in robotic salvage radical prostatectomy may improve overall survival, though its rates are low. Positive lymph node stage (pN1) is linked to worse cancer control outcomes.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- Salvage radical prostatectomy (s-RARP) is a treatment option for recurrent prostate cancer.
- Investigating surgical features that improve cancer control in s-RARP is crucial.
- Robotic approaches are increasingly used for s-RARP.
Purpose of the Study:
- To investigate the effect of lymph node dissection (LND) and pN stage on outcomes in robotic s-RARP.
- To evaluate the impact of LND on biochemical recurrence-free (BCR), metastases-free (MFS), and overall survival (OS).
Main Methods:
- A multicentric project involving 444 robotic s-RARP patients.
- Analysis of LND rates, number of lymph nodes removed, and pN stage.
- Comparison of BCR, MFS, and OS between patients with and without LND, and by pN stage.
Main Results:
- 63% of patients underwent LND (median 8 nodes). Patients without LND had higher rates of initial focal therapy and Gleason score 8-10.
- No significant difference in BCR or MFS was observed between patients with or without LND.
- LND was associated with improved OS (HR: 0.39, p=0.049).
- pN1 stage was linked to worse BCR-free survival (HR: 2.0, p=0.025).
Conclusions:
- LND rates are low in contemporary s-RARP, often performed in patients with poorer prognostic factors.
- LND may be associated with improved overall survival.
- pN1 stage is a significant predictor of worse cancer control outcomes.
