Comparison of lymph node yield in robot‐assisted laparoscopic prostatectomy with that in open radical retropubic prostatectomy

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

? To investigate both the feasibility and the adequacy of pelvic lymph node dissection (PLND) during robot‐assisted laparoscopic prostatectomy (RALP) by comparing lymph node yields obtained during RALP with those obtained during traditional open retropubic radical prostatectomy (RRP).

PATIENTS AND METHODS

? We retrospectively reviewed 1047 patients who underwent radical prostatectomy between 2001 and 2009. ? In all, 626 patients underwent RALP while 421 patients had traditional open RRP. All patients undergoing bilateral PLND were included in our analysis. ? Lymph node yields and lymph node involvement for each surgical approach were calculated and examined. ? PLND‐related complications were analysed.

RESULTS

? Of the 1047 patients, 816 patients underwent bilateral PLND of whom 473 underwent RALP, while 343 underwent RRP. The mean lymph node yields for the RALP cohort (7.1, interquartile range 4–10) was significantly higher (P < 0.001) than for the RRP cohort (6.0, interquartile range 3–8). ? The percentage of patients with nodal involvement was 1.1 for RALP and 2.3 for RRP (P= 0.167). ? Mean age, preoperative PSA values, and pre‐ and postoperative Gleason scores were similar between the two cohorts. ? PLND‐related complications were similar between both cohorts.

CONCLUSIONS

? In patients undergoing RALP, PLND is feasible and provides lymph node yields comparable with those of the standard open approach. ? PLND should be strongly considered in all radical prostatectomy patients when clinically indicated, regardless of surgical technique.