Prostate cancer lymph node (LN) recurrence after initial local treatment is usually treated with androgen-deprivation therapy. Positron emission tomography (PET-CT) with 68Ga-prostatic specific membrane antigen (PSMA) could early identify patients with only LN disease who may represent a particular group with more favorable outcomes. Previous data found favorable cancer control after salvage lymph node dissection (sLND). Most of previous series are open surgery, however robotic approach could have advantages. The aim of this video is to provide detailed description and video demonstration of salvage robot-assisted retroperitoneal lymphadenectomy (sRLND) technique and to report results of 10 initial cases.
Study group comprised 10 consecutive LN only recurrence prostate cancer patients, presented with biochemical recurrence (BCR) and lymph node uptake at PET-CT Scan, submitted to sRLND performed by from June/2015 to march/2017. Dissection template extends cranially from bellow mesenteric inferior artery at the aorta bifurcation up to obturator fossa bilaterally distally. Lateral dissection limit is genito-femural nerve. “Split and roll” technique, removing completely fatty-lymphatic tissue from vascular branches, was associated with clip-ligated distal lymphatic vessels and mono and bipolar hemostasis are used.
Median operative time, estimated blood loss and length of hospital stay were 2 hours, 100mL and 3 days, respectively. No patient had open conversion, blood transfusion or intraoperative complication. Positive LN was detected in 8 (80%) patients. Mean number of removed nodes and mean number of positive nodes per patient were 46 and 3, respectively. Overall, 8 (80%) patients achieved biochemical response after surgery. At 2 months postoperatively, median (range) PSA level was 0.096ng/mL (0.01 – 0.71), which reflects a median PSA level reduction of 89.9%.
Initial brazilian series of sRLND was presented, demonstrate safe and feasible to reduce morbity and improve number of LN removed. Salvage lymphadenectomy could improve oncological outcomes and achieves an immediate BCR in selected patients, but randomized controlled trials with longer follow up is necessary to long term assessment.