1. Robotic salvage lymph node dissection for nodal-only recurrences after radical prostatectomy: Perioperative and early oncological outcomes
- Author
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Zaid Al-Kailani, Stefan Siemer, Samer Ezziddin, Johannes Linxweiler, Michael Stöckle, Martin Janssen, Matthias Saar, and Carsten-Henning Ohlmann
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Choline ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Randomized controlled trial ,law ,Positron Emission Tomography Computed Tomography ,Humans ,Operation time ,Medicine ,Lymph node ,Aged ,Retrospective Studies ,Aged, 80 and over ,Prostatectomy ,Salvage Therapy ,business.industry ,Prostatic Neoplasms ,Perioperative ,Middle Aged ,Prognosis ,Survival Rate ,Dissection ,medicine.anatomical_structure ,Surgery, Computer-Assisted ,Oncology ,Median time ,Treatment modality ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Surgery ,Lymph Nodes ,Radiology ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Background Salvage lymph node dissection (sLND) – performed open or minimally-invasive - is a treatment modality that can be offered to patients with nodal recurrence after radical prostatectomy (RP), especially in times where modern imaging methods like choline- or PSMA-PET/CT are available. Yet, there are only very limited data on the safety and oncological effectiveness of robotic sLND. Methods We retrospectively identified patients who underwent robotic sLND at our institution between 2013 and 2017 for nodal recurrence after RP, which had been diagnosed either by 18F-choline- or 68Ga-PSMA-PET/CT. We analyzed perioperative data and early oncological outcomes with a focus on the comparison of patients with preoperative choline- vs. those with preoperative PSMA-PET/CT. Results We identified 36 patients who underwent robotic sLND at a median time of 45.3 months [range 3.1;228.6] after RP, with nodal recurrences detected in 25 patients by PSMA- and in 11 by choline-PET/CT. Median preoperative PSA, operation time and blood loss were 1.98 ng/ml [range 0.09;35.15], 129.5 min [range 65;202] and 50 ml [range 0;400], respectively. No high-grade complications occurred. A median number of 6.5 [range 1;25] lymph nodes were removed with a median of 1 [range 0;9] tumor-occupied node. None of the patients received any adjuvant treatment. Median postoperative PSA-change was −57% [range −100; +58] in the PSMA- and +10% [range −91; +95] in the choline-group (p = 0.015). 44% of patients in the PSMA- and 18% of patients in the choline-group experienced complete biochemical response (cBCR; PSA Conclusions This is the hitherto largest series on robotic sLND for nodal recurrence after RP. Robotic sLND is a feasible therapeutic option with low morbidity, which can at least delay the initiation of further therapy – in some patients up to several years. However, the extend of sLND has to be standardized and randomized trials are needed to finally define the oncological effectiveness of this approach.
- Published
- 2018
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