Login to Access Video or Poster Abstract: MP64-07
Sources of Funding: none

Introduction

For intermediate- and high-risk prostate cancer patients, an extended pelvic lymph node dissection (ePLND) template is recommended by NCCN and EAU guidelines at the time of prostatectomy. We report on 1000 robotic assisted-laparoscopic prostatectomy (RALP) patients who underwent an ePLND at a single institution.

Methods

From August 2010 to September 2016, 1000 patients underwent an ePLND during RALP. Our ELND technique includes as boundaries the ureteral crossing over the common iliac bifurcation proximally, the lateral border of the external iliac artery laterally, the node of Cloquet distally, as well as the obturator fossa. LNs were sent in 11 packets (bilateral common, external and internal iliacs, node of Cloquet, obturator and anterior bladder fat). Clinicopathological and lymph node (LN) data were obtained from our prospectively collected institutional database.

Results

61.9% patients were D’Amico intermediate-risk and 30.8% were high-risk. Median age was 64 years. Median PSA was 6.4. 33% were ? pT3. 24.7% had positive margins. The median LN yield was 20 and 2.1% of LNs removed were positive. LNs were positive in 17.4% of all patients including 9.7% of the intermediate- and 35.4% of the high-risk groups. Figure 1 illustrates the median LN yields. Figure 2 demonstrates the percentage of LN that were positive by packet location. 1.4% of patients received blood transfusion. 90-day complications were low and similar between risk groups with 2.2% having symptomatic lymphoceles requiring intervention and 0.8% having DVTs overall.

Conclusions

17.4% of 1000 RALP had positive LNs with an ePLND and complications were rare. Most common locations for metastasis were the obturator (39.8%) followed by external iliac packets (29.3%). To our knowledge, this is the largest series of robotic ePLND during RALP.

Funding

none