EURURO Vol. 72 No. 3

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had lymph node invasion and the median number of
positive nodes was 2 and a half. Overall, three (18.8%) and
five (31.3%) patients received adjuvant radiotherapy and
postoperative androgen deprivation therapy (ADT) after RP,
respectively. Median PSA at RASND was 1.0 ng/ml. Overall,
12 (75.0%), one (6.3%), two (12.5%), and one (6.3%) patients
had one, three, four, and five positive spots at PET/CT scan,
respectively. PET/CT scan was positive in the pelvis,
retroperitoneum, and pelvis + retroperitoneum in five
(31.3%), eight (50.0%), and three (18.7%) patients, respec-
tively.
3.2. Perioperative outcomes
The dissection included pelvic only, retroperitoneal only,
and pelvic + retroperitoneal stations in three (18.7%), one
(6.3%), and 12 (75.0%) patients, respectively. lists
perioperative parameters. Median operative time was
210 min. Median blood loss was 250 ml. Overall, four
(25.0%) patients experienced intraoperative complications,
which were represented by ureteral and vascular injuries in
one (6.3%) and three (18.7%) cases, respectively. Overall, one
(6.3%) and three (18.8%) patients had Grade 1 and
2 intraoperative complications according to the Satava
classification. Overall, five (31.2%) patients experienced
postoperative complications, which were classified accord-
ing to the Clavien-Dindo system as Grade I and II in one
(6.3%) and four (25.0%) patients, respectively. No Grade III–V
complications were observed. When considering nodal
dissection-related complications, one (6.3%) and one
(6.3%) patients experienced lymphedema and lymphor-
rhoea, respectively. These patients were managed conserva-
tively. None of the patients included in the study received
postoperative transfusions. No perioperative mortality was
observed. Median LoS was 3.5 d.
3.3. Pathologic results and BR
Overall, 11 (68.8%) patients had positive lymph nodes at
RASND ). The median number of nodes removed and
of positive nodes was 16.5 and four, respectively. Overall,
six (54.5%), two (18.2%), and three (27.3%) patients had
positive lymph nodes in the pelvic only, retroperitoneal
only, and pelvic + retroperitoneal regions, respectively.
Supplementary depicts the characteristics of
patients with negative lymph nodes at RASND (n = 5).
Overall, four patients had positive lymph nodes at
preoperative PET/CT scan in the pelvic region and one in
Table 2 – Perioperative outcomes of 16 patients treated with
robot-assisted salvage nodal dissection for biochemical and lymph
node recurrence after radical prostatectomy
Variable Value
Operative time (min)
Median (IQR) 210 (157–272)
Blood loss (ml)
Median (IQR) 250 (112–425)
Intraoperative complications according to Satava classification (%)
Overall 4 (25.0)
Incidents without consequences (Grade 1) 1 (6.3)
Incidents repaired intraoperatively (Grade 2) 3 (18.8)
Incidents requiring reintervention (Grade 3) 0 (0)
Type of intraoperative complication (%)
Ureteral lesion 1 (6.3)
Vascular injury (artery) 2 (12.5)
Vascular injury (vein) 1 (6.3)
Postoperative complications (%) 5 (31.2)
Type of postoperative complications (%)
Hyponatremia 1 (6.3)
Lymphedema 1 (6.3)
Lymphorrhoea 1 (6.3)
Obturator nerve neuropraxia 1 (6.3)
Fever 1 (6.3)
Ileus 1 (6.3)
Hydronephrosis 1 (6.3)
Clavien-Dindo classification (%)
I 1 (6.3)
II 4 (25.0)
III–V 0 (0)
Postoperative transfusion (%) 0 (0)
Length of stay (d)
Median (IQR) 3.5 (3–4)
IQR = interquartile range.
Table 1 – Baseline characteristics of 16 patients treated with robot-
assisted salvage nodal dissection (RASND) for biochemical and
lymph node recurrence after radical prostatectomy (RP)
Variable Value
Age at RASND (yr)
Median (IQR) 66 (59.2–72.7)
pT stage at RP (%)
pT2 4 (25.0)
pT3a 5 (31.3)
pT3b 6 (37.5)
pT4 1 (6.3)
Positive surgical margins at RP (%) 4 (25.0)
Pathologic Gleason score at RP (%)
7 9 (56.3)
8 2 (12.5)
9 5 (31.3)
pN stage at RP (%)
pNx 3 (18.8)
pN0 6 (37.5)
pN1 7 (43.8)
No. of lymph nodes removed at RP
Median (IQR) 19.5 (10–32)
No. of positive nodes at RP
Median (IQR) 2.5 (1.7–7.2)
Adjuvant radiotherapy after RP (%) 3 (18.8)
Time to BCR after RP (mo)
Median (IQR) 10 (3–41)
PSA at RASND
Median (IQR) 1.0 (0.25–2.75)
Salvage radiotherapy after RP (%) 5 (31.3)
ADT after RP (%) 5 (31.3)
No. of positive [11C]choline PET/CT sites (%)
1 12 (75.0)
2 0 (0)
3 1 (6.3)
4 2 (12.5)
5 1 (6.3)
[11C]choline PET/CT positive sites (%)
Pelvic only 5 (31.3)
Retroperitoneal only 8 (50.0)
Pelvic plus retroperitoneal 3 (18.7)
ADT = androgen deprivation therapy; BCR = biochemical recurrence;
CT = computed tomography; IQR = interquartile range; PET = positron
emission tomography; PSA = prostate-specific antigen.
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