Robotic salvage pelvic lymph node dissection for locoregional recurrence after radical prostatectomy: a single institution experience

Abstract

Objectives

To assess treatment response (PSA < 0.2 ng/ml), need for additional therapy and complication rate after robot assisted salvage pelvic lymph node dissection (sPLND)

Material and Methods

Analysis of outcomes data from radical prostatectomy (RP) patients consecutively operated with robot assisted sPLND due to biochemical recurrence and positron-emission tomography (PET)/computed tomography (CT)-detected nodal recurrence of pelvic lymph nodes.

Results

Sixty-nine patients underwent robotic sPLND after a median time of 47 months post- RP. Sixty-four patients (93%) had malignant lymph nodes upon histological assessment of sPLND specimen. Twenty patients (29%) achieved PSA < 0.2 ng/ml 6 weeks postoperatively. After median (IQR) follow-up of 15 months (10–27), fourteen patients (20%) still had PSA < 0.2 ng/ml without additional therapy and forty-one patients (59%) had started additional therapy. No significant predictor for treatment response was found. Postoperative complications occurred in 14 patients (20%). Eleven of these complications were classified as Clavien-Dindo grade 1

Conclusion

Oncological benefit of sPLND as the only salvage procedure seems to be limited, though almost one third of patients achieved treatment response. Clinical trials are needed to determine if sPLND as part of a multimodal treatment may improve outcome.

Keywords:

• Pelvic lymph node dissection
• prostate cancer
• robotic surgery
• PET/CT

Acknowledgements

Tor Åge Myklebust MSc Phd for excellent help creating waterfall figure. Dr Jon Roar Hoff for collection of follow up data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Radium Hospital Foundation which funded a DaVinci robot enabling this study.