191 Cancer-control outcomes in patients with clinically high-risk prostate cancer (PCa) treated with robotic-assisted laparoscopic radical prostatectomy (RALP): A multi-institutional database analysis

Abstract

INTRODUCTION AND OBJECTIVES: Contemporary adherence to European Association of Urology (EAU) guideline recommendation for pelvic lymph node dissection (PLND) at either open (ORP) or robot-assisted radical prostatectomy (RARP) in an European high-volume center is unknown. To assess guideline recommended and observed PLND rates at ORP or RARP in a high-volume center cohort. METHODS: We relied on a large European institutional database and focused on localized prostate cancer (PCa) patients, who were treated with either ORP or RARP, between 2010 and 2013. Categorical and multivariable logistic regression analyses targeted two endpoints: 1) probability of guideline recommended PLND and 2) probability of no PLND, when not recommended by EAU guidelines. RESULTS: Within 7,868 PCa patients, adherence to EAU PLND guideline recommendation was 97.1% at ORP and 96.8% at RARP. When PLND was not recommended, it was more frequently performed at RARP (71.6%) than at ORP (66.2%). At recommended PLND, 21.1% of ORP patients harbored lymph node invasion (LNI) (number needed to treat (NNT): 4.7) vs. 9.9% RARP (NNT: 10.1). At not recommended PLND, 2.9% of ORP patients harbored LNI (NNT: 34.5) vs. 1.4% in RARP (NNT: 71.4). CONCLUSIONS: Adherence to EAU guideline recommended PLND is high at this high-volume center. Neither ORP nor RARP represent a barrier for PLND, when recommended. However, a high number of patients underwent PLND despite absence of guideline recommendation. Possible staging advantages and PLND related complications needs to be individually considered, especially, when LNI risk is low.