The impact of robot-assisted radical prostatectomy on the use and extent of pelvic lymph node dissection in the "post-dissemination" period

G. Gandaglia, Q. D. Trinh, J. C. Hu, J. Schiffmann, A. Becker, F. Roghmann, I. Popa, Z. Tian, P. Perrotte, F. Montorsi, A. Briganti, P. I. Karakiewicz, M. Sun, F. Abdollah

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Abstract

Introduction Previous series during the dissemination era of minimally invasive techniques for treatment of prostate cancer (PCa) showed a declining use of pelvic lymph node dissection (PLND). The aim of our study was to re-assess the impact of robot-assisted radical prostatectomy (RARP) on the utilization rate of PLND and its extent in the post-dissemination period. Methods Relying on the Surveillance Epidemiology and End Results (SEER) Medicare-linked database, 5804 patients with non-metastatic PCa undergoing open radical prostatectomy (ORP) or RARP between years 2008 and 2009 were identified. Uni- and multivariable logistic regression analyses tested the relationship between surgical approach (RARP vs. ORP) and: 1 - the rate of PLND (pNx vs. pN0-1); and 2 - the extent of PLND (limited vs. extended). Results Overall, 3357 (57.8%) patients underwent a PLND. The proportion of patients treated with PLND was significantly higher among ORP vs. RARP patients: 71.2 vs. 48.6%, respectively (P <0.001). In addition, the median number of lymph nodes removed was significantly higher for patients treated with ORP vs. RARP: 5 vs. 4, respectively (P <0.001). In multivariable analyses, ORP was associated with 2.7- and 1.3-fold higher odds of undergoing PLND and of receiving an extended PLND compared to RARP, respectively (both P ≤ 0.001). Stratified analyses according to disease risk classifications revealed similar trends. Conclusions In the post-dissemination era, RARP remains associated with a decreased use of PLND and suboptimum extent. Efforts should be made to improve guideline adherence in performing a PLND whenever indicated according to tumor aggressiveness, despite surgical approach.

Original languageEnglish
Pages (from-to)1080-1086
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume40
Issue number9
DOIs
Publication statusPublished - 2014

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Keywords

  • Pelvic lymph node dissection
  • Prostate cancer
  • Radical prostatectomy
  • Robotic-assisted radical prostatectomy
  • Staging

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Gandaglia, G., Trinh, Q. D., Hu, J. C., Schiffmann, J., Becker, A., Roghmann, F., Popa, I., Tian, Z., Perrotte, P., Montorsi, F., Briganti, A., Karakiewicz, P. I., Sun, M., & Abdollah, F. (2014). The impact of robot-assisted radical prostatectomy on the use and extent of pelvic lymph node dissection in the "post-dissemination" period. European Journal of Surgical Oncology, 40(9), 1080-1086. https://doi.org/10.1016/j.ejso.2013.12.016