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

Figures & data

Table 1. Patient characteristics, n = 69.

Age at radical prostatectomy (RP) years, median (IQR)	62 (56–66)
Pre-RP PSA value (ng/ml), median (IQR)	13.0 (11.0 − 18.5)
Undetectable PSA after RP, n (%)
Yes	39 (56)
No	29 (41)
Unknown	1 (2)
Pathological T stage RP specimen, n (%)
pT2	17 (25)
pT3a	35 (51)
pT3b	17 (25)
Gleason score RP specimen, n (%)
ISUP grade group ≤ 2	18 (26)
ISUP grade group 3	22 (32)
ISUP grade group 4	23 (33)
ISUP grade group 5	6 (8)
Pathological nodal status, n (%)
pNx	39 (57)
pN0	21 (30)
pN1	9 (13)
Surgical margins, n (%)
Positive	17 (25)
Negative	52 (75)
Radiotherapy post –RP, n (%)	38 (54)

Table 2. Pre-, peri- and postoperative sPLND data stratified on mode of sPLND.

	sPLND overall n = 69	Targeted sPLND n = 30)	Unilateral extended n = 11	Bilateral extended n = 28	Intergroup differences
Age at sPLND, years, median (IQR)	67 (62–71)	67 (62–71)	68 (62–72)	67 (62–71)	p = 0.8
Months from RP, median (IQR)	49 (24–79)	36 (21–59)	79 (54–93)	53 (25–83)	p = 0.01
PSA at sPLND	1.4 (0.8–3.4)	1.4 (0.7–3.2)	1.6 (0.9–3.0)	1.9 (0.9–4.3)	p = 0.6
Number of positive PET/CT lesions per patient, n (%)
1	40 (57.7)	20 (66.7)	7 (58.3)	14 (50.0)	p = 0.4
2	19 (26.8)	5 (16.7)	3 (25.0)	11 (39.3)
≥3	10 (14.1)	5 (16.7)	2 (16.6)	3 (10.8)
Patients with malignant histology in sPLND specimen	63 (90)	26 (86.7)	9 (75.0)	28 (100)	p = 0.04
Number of excised nodes, median (IQR)	12 (7–19)	8 (3–12)	12 (7–18)	19 (12–25)	p < 0.001
Number of excised metastatic nodes, median (IQR)	2 (1–4)	1 (1– 3)	3 (1–5)	3 (1–5)	p = 0.1
Clavien Dindo grade of complications, n (%)
Grade 1*	11	5	1	7	p =0.4
Grade 2**	1	1	0	0
Grade 3a^#	1	0	0	1
Grade 3b^##	1	0	1	0

*8 patients with temporary lymphedema and 3 patients with neurapraxia.

**1 patient with deep venous thrombosis.

^#1 patient with drainage of abscess.

^##Injury of ureter.

Table 3. Oncological results during follow-up (n = 69).

Treatment response (PSA < 0.2 ng/ml) at 6 weeks post sPLND
Mode of sPLND, n (%)
Targeted sPLND	8/30 (27)*
Unilateral extended sPLND template	4/11 (36)*
Bilateral extended sPLND template	8/28 (29)*
Additional treatment at median (IQR) follow-up 15 months (10–27), n (%)
ADT	34 (49)
Salvage radiation	4 (6)
Re-sPLND	3 (4)
Patients without additional treatment and PSA < 0.2 ng/ml	14 (20)
Patients without additional treatment and PSA ≥ 0.2 ng/ml	14 (20)
Clinical recurrence at median (IQR) follow-up 15 months (10–27), n (%)
Number of patients with recurrence of lymph node metastasis	18 (26)
Number of patients with skeletal metastasis	2 (3)
Number of patients with visceral metastasis	2 (3)

*Chi-squared, p = 0.9.

Figure 1. Relative PSA-changes (post- versus preoperative values) after robotic sPLND are plotted in descending order from left to right with each bar depicting one patient.

Figure 2. Difference in PSA value pre-sPLND between patients without and with treatment response.

Figure 3. Covariates associated with treatment response (PSA < 0.2 ng/ml) in multivariate logistic regression. GGG: ISUP Gleason Grade Group.

Figure 4. Survival without additional treatment post-sPLND.