EURURO Vol. 72 No. 3

Surgery in Motion

Editorial by Riccardo Schiavina, et al on pp. 439–441 of this issue

Robot-assisted Salvage Lymph Node Dissection for Clinically

Recurrent Prostate Cancer

Francesco Montorsi

a , b ,

Giorgio Gandaglia

a , b , c , * ,

Nicola Fossati

a , b , c ,

Nazareno Suardi

a , b ,

Cristian Pultrone

c , d ,

Ruben De Groote

c ,

Zach Dovey

c ,

Paolo Umari

c ,

Andrea Gallina

a , b ,

Alberto Briganti

a , b ,

Alexandre Mottrie

Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy;

Vita-Salute San Raffaele University, Milan,

Italy;

OLV Vattikuti Robotic Surgery Institute, Melle, Belgium;

Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 4 3 2 – 4 3 8

available at

www.scienced irect.com

journal homepage:

www.europeanurology.com

Article info

Article history:

Accepted August 21, 2016

Associate Editor:

Giacomo Novara

Keywords:

Prostate Cancer

Radical Prostatectomy

Salvage Lymph Node Dissection

Locally Advanced

Robot-assisted

Abstract

Background:

Salvage lymph node dissection has been described as a feasible treatment for

the management of prostate cancer patients with nodal recurrence after primary treatment.

Objective:

To report perioperative, pathologic, and oncologic outcomes of robot-assisted

salvage nodal dissection (RASND) in patients with nodal recurrence after radical prostatec-

tomy (RP).

Design, setting, and participants:

We retrospectively evaluated 16 patients affected by

nodal recurrence following RP documented by positive positron emission tomography/

computed tomography scan.

Surgical procedure:

Surgery was performed using DaVinci Si and Xi systems. A pelvic nodal

dissection that included lymphatic stations overlying the external, internal, and common

iliac vessels, the obturator fossa, and the presacral nodes was performed. In 13 (81.3%)

patients a retroperitoneal lymph node dissection that included all nodal tissue located

between the aortic bifurcation and the renal vessels was performed.

Measurements:

Perioperative outcomes consisted of operative time, blood loss, length of

hospital stay, and complications occurred within 30 d after surgery. Biochemical response

(BR) was defined as a prostate-specific antigen level

0.2 ng/ml at 40 d after RASND.

Results and limitations:

Median operative time, blood loss, and length of hospital stay

were 210 min, 250 ml, and 3.5 d. The median number of nodes removed was 16.5. Positive

lymph nodes were detected in 11 (68.8%) patients. Overall, four (25.0%) and five (31.2%)

patients experienced intraoperative and postoperative complications, respectively. Over-

all, one (6.3%) and four (25.0%) patients had Clavien I and II complications within 30 d after

RASND, respectively. Overall, five (33.3%) patients experienced BR after surgery. Our study

is limited by the small cohort of patients evaluated and by the follow-up duration.

Conclusions:

RASND represents a feasible procedure in patients with nodal recurrence

after RP and provides acceptable short-term oncologic outcomes, where one out of three

patients experience BR immediately after surgery. Long-term data are needed to confirm

the effectiveness of this approach.

Patient summary:

We report our initial experience with robot-assisted salvage nodal

dissection for the management of patients with lymph node recurrence after radical

prostatectomy. This technique represents a feasible and effective approach, where no

high-grade complications were recorded and one out of three patients experienced

biochemical response at 40 d after surgery.

* Corresponding author. Division of Oncology/Unit of Urology, Urological Research Institute,

IRCCS Ospedale San Raffaele, Via Olgettina 58, Milan 20132, Italy. Tel. +39 0226437286;

Fax: +39 0226437286.

E-mail address:

giorgio.gandaglia@gmail.com

(G. Gandaglia).

http://dx.doi.org/10.1016/j.eururo.2016.08.051

0302-2838/