Lymph node dissection during robotic‐assisted laparoscopic prostatectomy: comparison of lymph node yield and clinical outcomes when including common iliac nodes with standard template dissection

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To compare the perioperative outcomes of standard pelvic to full‐template lymph node (LN) dissection (LND) during robotic‐assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS The study included 94 patients undergoing RALP with LND between January 2007 and August 2008, by one surgeon. In February 2008 the LND template was modified to include common iliac and medial hypogastric LNs. Clinical and pathological patient characteristics were analysed, including total number of retrieved and positive LNs in each area of dissection, operative duration and complications. RESULTS Of the 94 patients, 62 underwent standard LND (group 1) and 32 underwent full‐template pelvic LND (group 2). The median (mean) number of LNs retrieved in groups 1 and 2 were 12 (13.3) and 17.5 (21.4), respectively. Of the five patients with positive LNs (5%), four were in group 2 (13%); two of these patients had positive LNs in the common iliac dissection, and for one of these patients it was the sole site of involvement. Deep venous thrombosis, pulmonary embolism or transient neuropraxia occurred in six patients (five in group 1 and one in group 2). The median additional operative time for resection of common and internal LNs was 25 min. CONCLUSIONS LN yield increased and additional sites of LN metastases were identified during full‐template pelvic LND during RALP. This modification was not associated with an increased rate of complications. Derived benefits of including additional nodal dissection and the effect on staging accuracy remain to be determined.