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Robotic salvage retroperitoneal and pelvic lymph node dissection for ‘node-only’ recurrent prostate cancer: technique and initial series
- Source :
- BJU International. 120:401-408
- Publication Year :
- 2017
- Publisher :
- Wiley, 2017.
-
Abstract
- Objectives To describe the technique of robot-assisted high-extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for ‘node-only’ recurrent prostate cancer. Patients and Methods In all, 10 patients underwent robot-assisted sRPLND+PLND (09/2015–03/2016) for ‘node-only’ recurrent prostate cancer, as identified by 11C-acetate positron emission tomography/computed tomography imaging. Our anatomical template extends from bilateral renal artery/vein cranially up to Cloquet's node caudally, completely excising lymphatic-fatty tissue from aorto-caval and iliac vascular trees; RPLND precedes PLND. Meticulous node-mapping assessed nodes at four prospectively assigned anatomical zones. Results The median operative time was 4.8 h, estimated blood loss 100 mL and hospital stay 1 day. No patient had an intraoperative complication, open conversion or blood transfusion. Three patients had spontaneously resolving Clavien–Dindo grade II postoperative complications. The mean (range) number of nodes excised per patient was 83 (41–132) and mean (range) number of positive nodes per patient was 23 (0–109). Seven patients (70%) had positive nodes on final pathology. Node-positive rates per anatomical level I, II, III and IV were 28%, 32%, 33% and 33%, respectively. In patients with positive nodes, the median PSA level had decreased by 83% at the 2-month follow-up. Conclusion The initial series of robot-assisted sRPLND+PLND is presented, wherein we duplicate open surgery with superior nodal counts and decreased morbidity. Robot-assisted technical details for an anatomical LND template up to the renal vessels are presented. Longer follow-up is necessary to assess oncological outcomes.
- Subjects :
- Male
medicine.medical_specialty
Intraoperative Complication
Blood transfusion
Urology
medicine.medical_treatment
030232 urology & nephrology
Salvage therapy
03 medical and health sciences
0302 clinical medicine
Robotic Surgical Procedures
Recurrence
Positron Emission Tomography Computed Tomography
medicine.artery
medicine
Humans
Retroperitoneal Neoplasms
Renal artery
Vein
Lymph node
Aged
Salvage Therapy
medicine.diagnostic_test
business.industry
Prostatic Neoplasms
Middle Aged
Surgery
Dissection
medicine.anatomical_structure
Positron emission tomography
030220 oncology & carcinogenesis
Lymph Node Excision
Lymph Nodes
business
Subjects
Details
- ISSN :
- 14644096
- Volume :
- 120
- Database :
- OpenAIRE
- Journal :
- BJU International
- Accession number :
- edsair.doi.dedup.....0b809ef6a656938364523910bff4b6b9