V4-10 18 F-CHOLINE PET/CT GUIDED SUPEREXTENDED PLND FOR VERY HIGH RISK PCA. FEASIBILITY AND SURGICAL TECHNIQUE

Abstract

You have accessJournal of UrologyRobotics – Prostate/Novel Imaging1 Apr 2016V4-10 18 F-CHOLINE PET/CT GUIDED SUPEREXTENDED PLND FOR VERY HIGH RISK PCA. FEASIBILITY AND SURGICAL TECHNIQUE Giuseppe Simone, Riccardo Mastroianni, Rocco Papalia, Mariaconsiglia Ferriero, Francesco Minisola, Leonardo Misuraca, Gabriele Tuderti, Salvatore Guaglianone, Giovanni Muto, and Michele Gallucci Giuseppe SimoneGiuseppe Simone More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Rocco PapaliaRocco Papalia More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Francesco MinisolaFrancesco Minisola More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Giovanni MutoGiovanni Muto More articles by this author , and Michele GallucciMichele Gallucci More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1814AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent evidences have highlighted the potential benefits of surgical treatment for very high risk and oligometastatic prostate cancer (PCa) patients. In this video we highlight the surgical steps of a 18 fluoro-choline PET-CT guided superextended pelvic lymph node dissection (PLND) during robot assisted radical prostatectomy (RARP) in a 56 yr-old patient with a cT3/N1 Gleason 8 PCa. METHODS The patient was placed in a steep trendelemburg position and a 6 trocar access, as for a robot assisted radical cystectomy, was performed. Separate package PLND was performed to assess PET-CT accuracy. Surgical steps were: identification of inferior mesenteric artery and dissection of nodes around the IMA according to PET-CT; paraaortic and left common iliac node dissection; presacral node dissection; right PLND starting from the common iliac nodes towards the obturator fossa, dissecting the fossa of Marcille; external iliac, internaliliac and obturator node dissection; deflection of the sigma on the right side, and left PLND as described for the right side; extrafascial radical prostatectomy (not shown in the video). RESULTS Operative time was 190 minutes. Estimated blood loss was 130 mL. Postoperative course was uneventful and the patient was discharged on 3th postopeative day. Pathologist reported a pT3b Gleason score 9 PCa with extraprostatic extension, negative surgical margins and 24 positive nodes out of 40 dissected, confirming nodal metastases in the 4 nodal packages highlighted by the PET-CT scan (paraaortic/left common, distal right common, bilateral obturator). Postoperative 1-mo PSA level was 0.3 ng/mL. Patient started maximum androgen block and 9 mo postoperatively has undetectable PSA levels. CONCLUSIONS RARP demosntrated to be a feasible and safe procedure for locally advanced PCa. The use of 18-F-choline PET-CT is a rational guide to perform an imaging guided PLND for clinically node positive patients. Reduced invasiveness of this surgery and optimal nodal clearance may contribute to expand indication for surgery in this setting of patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e519-e520 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Giuseppe Simone More articles by this author Riccardo Mastroianni More articles by this author Rocco Papalia More articles by this author Mariaconsiglia Ferriero More articles by this author Francesco Minisola More articles by this author Leonardo Misuraca More articles by this author Gabriele Tuderti More articles by this author Salvatore Guaglianone More articles by this author Giovanni Muto More articles by this author Michele Gallucci More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...