V8-10 ROBOTIC SALVAGE RETROPERITONEAL AND PELVIC LYMPH NODE DISSECTION FOR “NODE-ONLY” RECURRENT PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate and Renal Oncology1 Apr 2017V8-10 ROBOTIC SALVAGE RETROPERITONEAL AND PELVIC LYMPH NODE DISSECTION FOR “NODE-ONLY” RECURRENT PROSTATE CANCER Carlos Fay, Andre Abreu, Daniel Park, Niero Rajarubendra, Daniel Melecchi Freitas, Giovanni Cacciamani, and Inderbir Gill Carlos FayCarlos Fay More articles by this author , Andre AbreuAndre Abreu More articles by this author , Daniel ParkDaniel Park More articles by this author , Niero RajarubendraNiero Rajarubendra More articles by this author , Daniel Melecchi FreitasDaniel Melecchi Freitas More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , and Inderbir GillInderbir Gill More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2346AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite primary treatment of prostate cancer with surgery or external radiation therapy, 20-40% of patients relapse within 5 years and 25-35% progress to metastatic disease. Salvage lymph node dissection has been proposed in patients with biochemical recurrence from prostate cancer and nodal involvement only, although the optimal template remains a question of debate. Herein we describe the technique of robotic high-extended salvage retroperitoneal and pelvic lymphadenectomy (sRPLND+PLND) for “node-only” recurrent prostate cancer. METHODS Twenty patients underwent robotic sRPLND+PLND for “node-only” recurrent prostate cancer after definitive primary treatment as identified by carbon-11 acetate PET/CT. Our anatomic template extends from bilateral renal artery and vein cranially up to Cloquets node caudally, completely excising lymphatic-fatty tissue from aorto-caval and iliac vascular trees. Meticulous node-mapping assessed nodes at 4 prospectively-assigned anatomic zones. RESULTS Median age at salvage RPLND was 64 (45-76), median BMI was 26.4 kg/m2 (21.4 - 41.2), previous primary treatment was radical prostatectomy in 17 patients (85%) and external radiation therapy in 4 patients (15%), median time from primary treatment was 32 months (4-160) and median PSA at sRPLND+PLND was 2.1 ng/dl (0.28 - 38.17). Median operative time was 5 hours (3.5-5.8), blood loss was 100 ml (50-300), and hospital stay was 1 day (1-3). No patient had intra-operative complication, open conversion or blood transfusion. Four patients had Clavien II post-operative complications: flank/scrotal ecchymosis in 1 patient (5%), chylous ascites in 2 patients (10%) and neuropraxia/foot drop in 1 patient (5%). Final histology confirmed positive nodes in 16 patients (20%). Mean and median (range) number of nodes excised per patient was 89 and 80 (41-132) respectively. Mean and median (range) number of positive nodes was 21 and 6 (0-109) respectively. At 2 months post-operatively median (range) PSA was 0.76 ng/mL (<0.01-2 ng/mL). CONCLUSIONS Herein we describe the detailed technique of robotic high-extended salvage RPLND+PLND for “node-only” recurrent prostate cancer and present the initial experience. Robotic sRPLND+PLND duplicates open surgery, with superior nodal counts and decreased morbidity compared to the published literature. Longer follow-up is necessary to assess oncologic outcomes. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e910 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Carlos Fay More articles by this author Andre Abreu More articles by this author Daniel Park More articles by this author Niero Rajarubendra More articles by this author Daniel Melecchi Freitas More articles by this author Giovanni Cacciamani More articles by this author Inderbir Gill More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...