Extended versus standard pelvic lymphadenectomy during robot-assisted radical prostatectomy: the role of extended template as an independent predictor of lymph node invasion with comparable morbidity burden

Abstract

BACKGROUND: To assess oncologic and surgical outcomes in patients subjected to standard (S) versus extended (E) pelvic lymph node dissection (PLND) during robot-assisted radical prostatectomy (RARP). METHODS: From February 2009 to December 2015 a total of 184 consecutive patients underwent RARP and either standard or extended PLND for localized prostate cancer (PCa). Descriptive statistics compared clinical and pathological variables between groups. Logistic regression identified potential predictors of lymph node invasion (LNI). RESULTS: No significant preoperative differences were found between the EPLND and SPLND groups. No difference in complication rates was observed between groups. No group differences were found for intraoperative blood loss, hospitalization times, positive surgical margins, biochemical recurrence, sexual dysfunction or need for adjuvant therapy. A higher median range of LN yield was found for the EPLND compared to SPLND cohort (22.5 vs. 12.8; P<0.001). Of the 36 patients who had positive LNs at the final pathology, 22 were in the EPLND group and 14 in the SPLND group (P<0.01). PSA, clinical stage and both number of nodes removed and EPLND were significant univariable predictors for LNI. In the multivariable model, PSA, clinical stage and number of removed nodes were independent predictors of LNI. EPLND was an independent predictor of LNI after accounting for PSA, clinical stage and Gleason Score stage. CONCLUSIONS: EPLND during RARP is safe and effective. It results in more removed nodes and a higher LN positivity rate compared to SPLND, predicting LNI without increasing complications.