Assessment of Lymph Node Yield After Pelvic Lymph Node Dissection in Men with Prostate Cancer: A Comparison Between Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy in the Modern Era

Abstract

No significant differences were seen in LNY during RARP and ORP for intermediate and high-risk men. For experienced surgeons, RARP can achieve equivalent LNY as ORP. A future study with a larger sample size is necessary to make a definitive statement of equivalence.

Quality of Evidence to Compare Outcomes of Open and Robot-Assisted Laparoscopic Prostatectomy

“…The selected studies are consistent with prior publications with mean estimated blood loss (EBL) ranging from 50 to 200 mL and 450 to 1,200 mL for RALP and RRP, respectively [6][7][8][9]. RALP is consistently associated with a decreased need for blood transfusion, with transfusion rates ranging from 0% to 5.1% versus 3% to 65% for RRP [6, 7, 10-13, 14••, 15-17].…”

“…Four studies compared LND in RALP and RRP, three of which observed statistically significant higher lymph node yields (LNY) in the RRP groups [13,35,36]. Mean LNY was 6 to 14.4 in RRP patients and 7.1 to 9.3 in RALP patients [9,35,36]. Although not statistically significant, one study trended toward a higher mean LNY in RRP, but was ultimately underpowered due to small sample size [9].…”

“…Mean LNY was 6 to 14.4 in RRP patients and 7.1 to 9.3 in RALP patients [9,35,36]. Although not statistically significant, one study trended toward a higher mean LNY in RRP, but was ultimately underpowered due to small sample size [9]. Many of the authors concede that comparing LNY in RRP and RALP groups is difficult due to inherent differences in specimen retrieval and pathologic processing.…”

“…Based on these studies, we are unable to determine if differences in transfusion rates between RALP and RRP could be influenced by variation in hemoglobin thresholds for initiating a transfusion. [6,8,9,13,15,16]. Depending on the study, operative time for RRP was longer, shorter, or not significantly different when compared to RALP.…”

Extended Pelvic Lymph Node Dissection Including Internal Iliac Packet Should Be Performed During Robot-Assisted Laparoscopic Radical Prostatectomy for High-Risk Prostate Cancer

“…[11][12][13] Moreover, recent reports have demonstrated that PLND during RALP provided a high lymph node yield and appeared to have minimal morbidity compared with the open technique. [13][14][15] Therefore, we assessed whether the extent of PLND at RALP had any benefit on lymph node yield, staging accuracy, and biochemical recurrence (BCR) in patients with high-risk prostate cancer.…”