WASHINGTON, DC USA (UroToday.com) - This presentation suggests that pelvic lymph node dissection (PLND) for prostate cancer can be performed with similar quality by open retropubic radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted laparoscopic prostatectomy (RALP).
They sought to compare outcomes of PLND with inclusion of the hypogastric nodal region in patients undergoing a radical prostatectomy performed by the differing surgical approaches in contemporaneous patient cohorts with standardized indications and uniform templates. To do this they studied patients undergoing surgery between January and September 2010. PLND was performed on all patients with any AUA intermediate or high-risk criteria and in low-risk patients at the surgeon’s discretion. For all approaches, a standardized template included the external, obturator, and hypogastric nodal packets. Differences in lymph node yield (LNY) between surgical approaches were compared using multivariable linear regression with adjustment for clinical stage, biopsy Gleason grade, PSA, and age.
A total of 475 patients (187 RRP, 114 LRP, 174 RALP) were included in this analysis and 399 (84%) underwent LND. They found no significant differences in oncologic characteristics between surgical approaches. The median LNY for RRP, LRP and RALP were 18, 17, and 16, respectively. Differences between groups were statistically significant after adjustment for stage, grade, PSA and age (p=0.036). Rates of LNI in this series were high regardless of surgical approach, likely due to the inclusion of the hypogastric packet (14% ORP, 7% LRP and 12% RALP) and were present in 1 of 76 (1%) of low-risk and 44 of 323 (14%) intermediate and high-risk patients. There was no significant difference in LNI between approaches. Overall, LND was performed in 98% (N=323) of patients with any intermediate or high-risk criteria.
Presented by Jonathan Silberstein, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.
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