Standardized and Simplified Robot-assisted Superextended Pelvic Lymph Node Dissection for Prostate Cancer: The Monoblock Technique

• Published in: European urology 2020-09, Vol.78 (3), p.424-431
• Main Authors: Mattei, Agostino, Würnschimmel, Christoph, Baumeister, Philipp, Hyseni, Ajet, Afferi, Luca, Moschini, Marco, Mordasini, Livio, Grande, Pietro
• Format: Article
• Language: English
• Subjects: Monoblock technique; Prostate cancer; Robot-assisted radical prostatectomy; Superextended pelvic node dissection
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2020.03.032

Extended pelvic lymph node dissection (ePLND) remains the most accurate procedure for lymph node staging in intermediate- and high-risk prostate cancer (PCa) patients undergoing radical prostatectomy (RP). A superextended pelvic lymph node dissection (sePLND) can be considered in selected very-high-risk PCa patients. To demonstrate a reproducible robot-assisted technique for sePLND at the time of RP for PCa. From June 2016 to August 2019, 41 consecutive patients with localized PCa and very high risk for lymph node invasion (LNI) received a robot-assisted RP and a standardized 10-step monoblock ePLND, followed by a 5-step monoblock sePLND. Very high risk for LNI was defined as ≥30% risk for LNI, as calculated by the Briganti 2017 nomogram. After performing the ePLND template resection (harvesting lymph nodes from the obturator region, external and internal iliac vessels, and common iliac vessels up to the ureter crossing), the 5-step monoblock sePLND approach was performed. The sePLND template was tailored to the common iliac vessels up to the aortic and caval bifurcation as well as the presacral region. Lymph node yield, perioperative complications. Overall, 41 patients received sePLND, reporting a median (interquartile range [IQR]) number of nodes removed of 23 (19–29). Median operative time (including RP, ePLND, and sePLND) was 256 min. Median preoperative prostate-specific antigen was 12 ng/mL (IQR 6.45–17.6). Disease stage pT