Comparing conventional laparoscopic to robotic-assisted extended pelvic lymph node dissection in men with intermediate and high-risk prostate cancer: a matched-pair analysis.

Abstract

In intermediate and high-risk prostate cancer patients, a robotic-assisted approach is increasingly being used for prostatectomy and extended pelvic lymph node dissection (ePLND). This is reducing the number of conventional laparoscopic radical prostatectomies (LR P) and laparoscopic ePLNDs for prostate cancer in Europe. Aim of this study is to compare laparoscopic ePLND to robotic-assisted ePLND in a cohort of patients with intermediate and high risk prostate cancer. We performed a matched-pair analysis matching 1:1 70 patients who underwent LRP+ePLND (2004-2009) to 70 who underwent RAR P+ePLND (2010-2014). All patients presented with intermediate or high-risk prostate cancer according to D'Amico classification. Patients were retrospectively analyzed. Differences in pathologic characteristics and postoperative complications across the two groups were assessed using Wilcoxon Rank sum or χ2 Test. LRP was associated with shorter OR times and decreased blood loss (P<0.001). However, in the robotic-assisted arm, more lymph nodes were retrieved (18 vs. 12; P<001). No significant difference in positive surgical margins was found across the two techniques (P=0.9). Lymphocele formation and prolonged lymphorrea were specifically addressed as complications, with no significant difference emerging from our analyses (P>0.74). In this matched-pair analysis comparing patients with intermediate and high-risk prostate cancer, a robotic-assisted approach was associated to a higher lymph node yield compared to conventional laparoscopy. However, this increase in node yield was balanced with longer OR times, increased blood loss, similar postoperative complications and similar oncologic outcomes. Larger and prospective studies in patients at high risk are necessary to validate these findings.