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Finally, RASND led to BR at 40 d after surgery inmore than
30% of patients included in our cohort. Although only studies
with a higher number of patients and a longer follow-up
could provide definitive answers on the oncologic safety of
this approach, this figure is in line with what reported by
previous investigations and should reassure regarding the
effectiveness of the robotic technique . When
evaluating the intermediate-term efficacy of salvage lymph
node dissection in open series, the majority of patients
experienced BCR after surgery. Nonetheless, up to 50% of
the men undergoing this surgical procedure were free
from CR and onset of distant metastases at 5-yr follow-up
and less than 30% of them died from PCa at this time point
. Therefore, it has been hypothesized that one
rationale for the adoption of this salvage approach would be
to defer the administration of systemic therapies and their
side effects This is true also in our series, where only
50% of the patients evaluated received ADT immediately
after RASND. Of note, BR, involvement of the retroperitoneal
lymph nodes, PSA at salvage lymph node dissection, and the
number of positive nodes have been proposed as prognostic
factors for recurrence after surgery and should be considered
to carefully select men who would benefit from this
approach
Taken together, these observations support the safety and
efficacy of RASND in selected PCa patients with nodal
recurrence after RP documented by PET/CT scan. However,
some limitations apply to our study. This investigation
represents our initial experience with the robotic approach
and a higher number of patients are needed to confirm the
safety and efficacy of RASND. Under this light, the relatively
small cohort evaluated in our study prevented us from
comprehensively addressing the impact of the surgeon on
perioperative, pathologic, and oncologic outcomes. Similar-
ly, a longer follow-up and, ideally, a control group are needed
to comprehensively assess the oncologic safety of RASND
compared with currently available therapeutic options in
this setting. Moreover, the inclusion of patients treated in
two different centers might have introduced elements of
inhomogeneity in perioperative patient management and
pathologic evaluation of nodal specimens. However, our
study takes advantage of the involvement of two tertiary
referral centers. Lastly, two experienced high-volume
robotic surgeons performed RASND and results obtained
in this context might not be generalizable to other settings
.
5. Conclusions
RASND represents a safe and feasible surgical procedure in
PCa patients with nodal recurrence documented by PET/CT
scan after RP, where no high-grade complications or
perioperative mortality were recorded. This approachmight
have an impact on the natural history of patients with nodal
recurrence and one out of three patients treated with
RASND experience BR immediately after surgery. Long-term
data are needed to confirm the oncologic effectiveness of
this therapeutic option.
Author contributions: Giorgio Gandaglia had full access to all the data in
the study and takes responsibility for the integrity of the data and the
accuracy of the data analysis.
Study concept and design: Montorsi, Gandaglia, Mottrie.
Acquisition of data: Fossati, Umari, Gallina, Dovey, De Groote, Pultrone,
Gandaglia.
Analysis and interpretation of data: Gandaglia, Briganti, Suardi, Montorsi.
Drafting of the manuscript: Gandaglia, Briganti, Suardi, Montorsi.
Critical revision of the manuscript for important intellectual content:
Mottrie, Montorsi, Suardi, Briganti.
Statistical analysis: Gandaglia.
Obtaining funding: None.
Administrative, technical, or material support: None.
Supervision: Mottrie, Montorsi, Briganti.
Other: None.
Financial disclosures: Giorgio Gandaglia certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affiliation, grants or funding, consultan-
cies, honoraria, stock ownership or options, expert testimony, royalties,
or patents filed, received, or pending), are the following: None.
Funding/Support and role of the sponsor: None.
Appendix A. Supplementary data
The Surgery in Motion video accompanying this article can
be found in the online version at
and via
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