Editorial Comment

Abstract

Pelvic lymph node dissection (PLND) and its extent during radical prostatectomy (RRP) continue to be hotly debated. PLND is performed infrequently during RRP, with open and minimally invasive surgeries, especially in low-risk patients, owing to low yield of positive nodes, longer operative time, and the risk of vascular injury or lymphoceles. That trend seems to be shifting toward performing PLND in patients with high-risk prostate cancer, because PLND provides accurate staging, indicating patients who should be considered for adjuvant therapy or at least followed up closely, 1 Touijer K. Rabbani F. Otero J.R. et al. Standard versus limited pelvic lymph node dissection for prostate cancer in patients with a predicted probability of nodal metastasis greater than 1%. J Urol. 2007; 178: 120-124 Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar and because PLND during RRP seems to cure, or is at least associated with, long-term survival in some patients with positive nodes. 2 Schumacher M.C. Burkhard F.C. Thalmann G.N. et al. Good outcomes for patients with few lymph node metastases after radical retropubic prostatectomy. Eur Urol. 2008; 54: 344-349 Abstract Full Text Full Text PDF PubMed Scopus (175) Google Scholar The current debate is about what is the necessary template (limit) of a PLND during RRP, and what should we call it? And can PLND be done in a timely and complete fashion using the robot? Pelvic Lymphadenectomy During Robot-assisted Radical Prostatectomy: Assessing Nodal Yield, Perioperative Outcomes, and ComplicationsUrologyVol. 74Issue 2PreviewTo describe our pelvic lymphadenectomy (PLND) technique during robot-assisted radical prostatectomy and to evaluate the nodal yield and perioperative outcomes. PLND is commonly performed with radical prostatectomy for localized prostate cancer. Because of the limitations of the robotic arm pitch in accessing the pelvic sidewall and undersurface of the iliac bifurcation, uro-oncologists have questioned the adequacy of robotic PLND. Full-Text PDF Editorial CommentUrologyVol. 74Issue 2PreviewThe preceding article is a timely report that addresses an important aspect of robotic radical prostatectomy, namely, the need for, and, most importantly, the adequacy of, nodal dissection. This has, for the most part, been overlooked in high-volume robotic series and only recently emphatically emphasized in high-volume open radical prostatectomy series. The recent report by Schumacher et al.1 is appropriately cited in the present report. It presents sobering data and survival outcomes in favor of extended pelvic lymphadenectomy, even in the prostate-specific antigen era. Full-Text PDF ReplyUrologyVol. 74Issue 2PreviewIt has been well demonstrated in non-neurologic malignancies (breast, lung, gastric, and colorectal) as well as in bladder cancer that regional lymphadenectomy is both diagnostic and therapeutic, and that the added survival benefit depends on the number of lymph nodes removed. Although it is universally accepted that pelvic lymph node dissection (PLND) during radical prostatectomy is a reliable staging tool, its role and potential benefit for patients with prostate cancer are still controversial. Full-Text PDF