Robot-assisted laparoscopic pelvic lymph node dissection for high-risk prostate cancer:Status quo and re-recognition of the strategy
Objective:To explore the clinical significance of extended pelvic lymph node dissection(EPLND)under the ro-bot-assisted laparoscope in the treatment of high-risk PCa.Methods:This study included 29 cases of high-risk PCa treated by robot-assisted laparoscopic radical prostatectomy and EPLND from April 2020 to January 2023.We collected the general data on the patients,recorded the status of dissection of the lymph nodes and postoperative complications,and analyzed the significance of EPLND.Results:The patients were aged(69.3±6.6)years old,with the preoperative PSA level of 8.43-434 μg/L,Gleason score(GS)6 in 1,GS 7 in 9,and GS ≥ 8 in 19 cases.The operation time averaged(97.2±15.7)min,with the mean blood loss of(30.5±11.2)ml,and 3-42(median=13)lymph nodes dissected,less than 10 in 10 cases,11-19 in 12,and more than 20 in 7.Posi-tive pelvic lymph nodes(median=4)were found in 13 cases,with a positive rate of 44.8％.Positive incisal margin was observed in 11 cases(37.9％),lymphovascular invasion(LVI)in 4(13.8％),and perineural invasion(PNI)in another 4(13.8％).Lymph node metastasis was significantly correlated with positive incisal margin(P＜0.05),but not with LVI,PNI or age(P＞0.05).No significant vascular or nerve injuries occurred during the operation.GS 6 was detected in 1,GS 7 in 7,and GS ≥8 in 21 cases postop-eratively.Conclusion:Robot-assisted laparoscopic EPLND is an important strategy for the treatment of high-risk PCa,which con-tributes to accurate pathological staging of the malignancy.However,evidence is lacking for its benefit to the survival of high-risk PCa patients,and more follow-up studies are needed to confirm its treatment effect.
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