The impact of robotic surgery on pelvic lymph node dissection during radical prostatectomy for localized prostate cancer: the Brown University early robotic experience

Abstract

Introduction: Open pelvic lymph node dissection (PLND) remains the gold standard in patients with intermediate and high-risk prostate cancer undergoing radical retropubic prostatectomy (RRP). Recently, our institution has adopted robotic assistance for performing radical prostatectomy. We sought to determine whether robot-assisted laparoscopic PLND yields comparable numbers of lymph nodes compared to open PLND.

Methods: The medical records of patients undergoing open or robot-assisted laparoscopic radical prostatectomy (RALRP) with concurrent pelvic lymph node dissection (PLND) between 2003 and 2008 were reviewed. Demographic factors including age, PSA, and Gleason score were recorded. Pathology reports were reviewed to determine the number of pelvic lymph nodes obtained during PLND. Lymph node yield was further evaluated based on surgeon. Student's t-test was used to compare the number of lymph nodes obtained with each method.

Results: A total of 61 patients undergoing open RRP with PLND and 62 patients undergoing RALRP with PLND were included. The mean number of lymph nodes obtained via open PLND was 7.3 while the mean number obtained via robotic PLND was 3.3. These means were significantly different with a p value < 0.001. One patient in the open cohort (1.6%) and two patients in the robotic cohort (3.2%) had micrometastatic disease on PLND.

Conclusion: Robot-assisted laparoscopic PLND yielded fewer lymph nodes compared to open PLND at the time of radical prostatectomy for organ confined disease. Patients with higher risk disease may benefit from open prostatectomy with PLND early in a program's robotics experience. These findings may be related to the relative youth of our robotics program and further comparisons as our data mature will be revealing.