Institutional impact on number of pelvic lymph nodes retrieved during RALRP while using robotic and open prostatectomy.
Open pelvic lymph node surgery (PLND) remains the best choice in patients with transitional and high-risk prostate cancer undergoing radical retro-pubic prostatectomy (RRP). A group in Rhode Island has adopted robotic-assisted for radical prostatectomy. They wanted to conclude whether robot-assisted laparoscopic PLND yields equivalent numbers of lymph nodes in comparison with open PLND.
After the approval of IRB institute, the databases of open and robotic prostatectomy reviewed at this institution. Patients undergoing RALRP with robotic PLND over a period of one year and patients undergoing open radical prostatectomy with open PLND within the last 5 years were documented. The pathology reports of surgery were keenly examined again to decide the number of lymph nodes obtained from each surgery of PLND. Statistical analysis was performed using Student’s t-test.
A total of 80 patients were marked, out of them 28 underwent robot-assisted PLND (2007) and 52 open PLND (2002 to 2007). The average number of lymph nodes acquired during robotic PLND was 3.2 and the mean number by open PLND was 6.9 (p< 0.001). In each legion one patient had micro-metastatic disease on PLND like both patients had biopsy which confirmed Gleason 7 prostate cancer with PSA less than 10. No major complications exist in either group that could be endorsed to the PLND.
In this study, robot-assisted laparoscopic PLND conceded fewer lymph nodes as compared to open PLND in radical prostatectomy for organ-confined disease. In men high-risk of lymph node involvements depend upon preoperative staging. Open PLND yields a great number of lymph nodes in comparison with robotic PLND in this surgical sequence and should be remained the gold standard.
Presented by Jennifer Yates, MD, Joseph Renzulli, MD, Harry Iannotti, MD, George E Haleblian, MD, and Gyan Pareek, MD at the Annual Meeting of the American Urological Association (AUA) – May 22nd, 2008. Orange County Convention Center – Orlando, Florida, USA.
Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS.
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