Converting From Open To Robotic Prostatectomy: Institutional Impact On Number Of Pelvic Lymph Nodes Retrieved During RALRP

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 06 Jun 2008 - 8:00 PDT

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ORLANDO, FL (UroToday.com) - Open pelvic lymph node dissection (PLND) remains the gold standard in patients with intermediate and high-risk prostate cancer undergoing radical retropubic prostatectomy (RRP). A group from Rhode Island has adopted robotic-assisted radical prostatectomy. They sought to determine whether robot-assisted laparoscopic PLND yields comparable numbers of lymph nodes compared to open PLND.

After obtaining institutional IRB approval, the open and robotic prostatectomy databases at this single institution were reviewed. Patients undergoing RALRP with robotic PLND over a 1 year period and patients undergoing open radical prostatectomy with open PLND within the last 5 years were identified. The surgical pathology reports were reviewed to determine the number of lymph nodes obtained with each method of PLND. Statistical analysis was performed using Student's t-test.

A total of 80 patients were identified, of whom 28 underwent robot-assisted PLND (2007) and 52 open PLND (2002 to 2007). The mean number of lymph nodes obtained during robotic PLND was 3.2 and the mean number obtained by open PLND was 6.9 (p< 0.001). One patient in each cohort had micro-metastatic disease on PLND; both patients had biopsy-proven Gleason 7 prostate cancer with PSA less than 10. There were no major complications in either group that could be attributed to the PLND.

In this study, robot-assisted laparoscopic PLND yielded fewer lymph nodes compared to open PLND at the time of radical prostatectomy for organ-confined disease. In men with high-risk of lymph node involvement based on preoperative staging, open PLND yields a higher number of lymph nodes compared to robotic PLND in this surgical series and should be considered the gold standard.

Presented by Jennifer Yates, MD, Joseph Renzulli, MD, Harry Iannotti, MD, George E Haleblian, MD, and Gyan Pareek, MD at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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