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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Oncol. | doi: 10.3389/fonc.2019.00781

Comparison of peri-operative and early oncological outcomes of robot-assisted versus open salvage lymph node dissection in recurrent prostate cancer.

 Gaëtan Devos1*,  Tim Muilwijk1, Yannic Raskin1, Victor Calderon1,  Lisa Moris1,  Thomas Van Den Broeck1,  Charlien Berghen1, Gert De Meerleer1, Maarten Albersen1, Hendrik Van Poppel1, Wouter Everaerts1 and  Steven Joniau1
  • 1University Hospitals Leuven, Belgium

ABSTRACT:

Introduction:
Salvage lymph node dissection (sLND) has been proposed as a treatment option for prostate cancer patients with lymph node (LN) recurrence following radical prostatectomy to delay or avoid palliative androgen deprivation therapy (ADT). Historically sLND has been performed using an open approach, with its associated morbidity. A limited number of studies have reported peri-operative outcomes following robot-assisted sLND. However, a direct comparison with the open approach has hitherto not yet been reported. This study investigates whether robot-assisted sLND is associated with better peri-operative outcomes compared to the open approach. Early oncological outcomes are also compared.

Patients and methods:
In this retrospective study, clinical data were collected from 60 patients undergoing open sLND between 2010-2016 and 30 patients undergoing robot-assisted sLND between 2016 and 2018 at our tertiary referral center. The primary objective of the study was to compare peri-operative outcomes (length of stay, estimated blood loss, operative time, intra-operative and postoperative complications) and LN yield between both procedures. As secondary objective early oncological outcome (biochemical recurrence-free survival (BRFS) and clinical recurrence-free survival (CRFS)) was compared. Variables of interest were compared using the chi-squared test (categorical variables), two sample t-test, and Mann-Whitney U test (continuous variables). To compare BRFS and CRFS, Kaplan-Meier analysis and log-rank tests were performed.


Results:
Robotic sLND was associated with reduced blood loss (median 100 vs. 275cc; p<0.0001) and shorter length of stay (median 2 vs. 7 days; p<0.0001) compared to open sLND. Moreover, postoperative complications within 30 days after surgery were more prevalent in the open sLND group compared to the robotic group (41.6% vs. 20%, p=0.04). No significant differences in LN yield (for each sLND template), BRFS and CRFS were detected between both groups.

Conclusion:
Robot-assisted sLND is associated with significantly reduced peri-operative morbidity compared to open sLND. No difference in LN yield, BRFS and CRFS was seen between both groups. Modern imaging techniques underestimate the tumor burden and therefore, the surgical sLND template should not be limited to the positive spots on pre-operative imaging.

Keywords: prostate cancer, Salvage lymph node dissection, robot assistance, Open procedure, Comparison of techniques

Received: 14 Jun 2019; Accepted: 01 Aug 2019.

Edited by:

Nicholas Zaorsky, Penn State Hershey Cancer Institute, United States

Reviewed by:

Sanja Štifter, Faculty of Medicine, University of Rijeka, Croatia
Philipp Mandel, University Medical Center Hamburg-Eppendorf, Germany  

Copyright: © 2019 Devos, Muilwijk, Raskin, Calderon, Moris, Van Den Broeck, Berghen, De Meerleer, Albersen, Van Poppel, Everaerts and Joniau. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Gaëtan Devos, University Hospitals Leuven, Leuven, Belgium, gaetan.devos@uzleuven.be