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EAU 2018

EAU 2018: Against Robotic Assisted Salvage Lymphadencetomy

Copenhagen, Denmark (UroToday.com) Dr. Heidenreich gave an overview of why salvage lymph node dissection (SLND) after local treatment for prostate cancer should be done as an open procedure and not as a robotic procedure. It is important to remember that the oncologic benefit of SLND is still uncertain. Most experience gained so far, has been achieved from open procedures. There is evidence that better oncological outcomes can be achieved with open procedure compared to robotic. Open procedure has shorter OR times, shorter hospital stay and low treatment associated complications in experienced hands.

When performing SLND, it is important to perform an extended ipsilateral template. There are several series of open SLND encompassing almost 400 patients, while there are only 2 substantial series on robotic SLND encompassing only 45 patients with a follow-up of 12 months. When looking at the largest series to date, 43.5% of patients after open SLND remain ADT free at 3 years, and 24.6% are biochemical recurrence (BCR) free at 3 years, while 23% of the robotic SLND patients remain BCR free at 1 year of follow-up.

Due to previous local treatment of prostate cancer, there is extensive intraperitoneal mobilization of the urinary bladder, and radiotherapy causes significant fibrosis in the pelvis. These result in the mean OR time for open SLND to be 2.1 hours, while it is 4.8 hours for robotic SLND.

In conclusion, SLND is still an experimental procedure. It is important not to resect only the PSMA positive node, but do a full extended ipsilateral template. Based on the current evidence, open SLND represents the approach of choice in regard to oncologic and safety data. To date there is no benefit to the robotic approach, demonstrating inferior oncologic results.

Speaker: Axel Heidenreich, Cologne, Germany

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark

Read More:
Support of Robot-assisted Salvage Lymph Node Dissection for Clinically Recurrent Prostate Cancer