652 UNIFORM ANATOMIC TEMPLATE FOR PELVIC LYMPH NODE DISSECTION DURING RADICAL PROSTATECTOMY: COMPARISON OF OPEN, LAPAROSCOPIC AND ROBOT-ASSISTED PROCEDURES (2011)

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 2011652 UNIFORM ANATOMIC TEMPLATE FOR PELVIC LYMPH NODE DISSECTION DURING RADICAL PROSTATECTOMY: COMPARISON OF OPEN, LAPAROSCOPIC AND ROBOT-ASSISTED PROCEDURES Jonathan Silberstein, Andrew Vickers, Nicholas Power, Raul Parra, Jonathan Coleman, Rodrigo Pinochet, Karim Touijer, Peter Scardino, Bertrand Guillonneau, James Eastham, and Vincent Laudone Jonathan SilbersteinJonathan Silberstein New York City, NY More articles by this author , Andrew VickersAndrew Vickers New York City, NY More articles by this author , Nicholas PowerNicholas Power New York City, NY More articles by this author , Raul ParraRaul Parra New York City, NY More articles by this author , Jonathan ColemanJonathan Coleman New York City, NY More articles by this author , Rodrigo PinochetRodrigo Pinochet New York City, NY More articles by this author , Karim TouijerKarim Touijer New York City, NY More articles by this author , Peter ScardinoPeter Scardino New York City, NY More articles by this author , Bertrand GuillonneauBertrand Guillonneau New York City, NY More articles by this author , James EasthamJames Eastham New York City, NY More articles by this author , and Vincent LaudoneVincent Laudone New York City, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1568AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to compare outcomes of lymph node dissection (LND), with inclusion of the hypogastric nodal region, in patients undergoing a radical prostatectomy (RP) performed by differing surgical approaches—open radical retropubic (ORP), laparoscopic (LRP) or robot-assisted laparoscopic prostatectomy (RALP)— in contemporaneous patient cohorts with standardized indications and uniform templates. METHODS Between January 1, 2010 and September 1, 2010 we analyzed all patients who underwent primary RP regardless of surgical approach. LND was performed on all patients with any AUA intermediate or high risk criteria (PSA≥10ng/ml, clinical stage ≥cT2b or any component ≥Gleason 4), and in low risk patients at the surgeon's discretion. A standardized template including the external, obturator, and hypogastric node packets was used, regardless of approach. Differences in lymph node yield (LNY) between surgical approaches were compared using multivariable linear regression with adjustment for clinical stage (T1c, T2a, T2b+), biopsy Gleason grade (6, 7, 8+), PSA, and age. RESULTS A total of 475 patients (187 RRP, 114 LRP, 174 RALP) were included in this analysis and 399 (84%) underwent LND. We found no significant differences in oncologic characteristics, including PSA, clinical stage, biopsy Gleason score, pathologic stage, and calculated risk of lymph node involvement (LNI), 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 (p=0.2). Overall, LND was performed in 98% (N=323) of patients with any intermediate or high risk criteria, regardless of approach. CONCLUSIONS LND, including the hypogastric nodal packet, can be performed by any approach with slightly different LNY but similar pathologic outcomes. Higher rate of LNY and LNI relative to prior series is commensurate with standardization to a uniform template which includes hypogastric nodes and particularly evident among higher risk cases. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e264 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Silberstein New York City, NY More articles by this author Andrew Vickers New York City, NY More articles by this author Nicholas Power New York City, NY More articles by this author Raul Parra New York City, NY More articles by this author Jonathan Coleman New York City, NY More articles by this author Rodrigo Pinochet New York City, NY More articles by this author Karim Touijer New York City, NY More articles by this author Peter Scardino New York City, NY More articles by this author Bertrand Guillonneau New York City, NY More articles by this author James Eastham New York City, NY More articles by this author Vincent Laudone New York City, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...