Aim

Extended pelvic lymph node dissection (EPLND) at the time of robotic prostatectomy is controversial despite being the gold standard for identifying microscopic lymph node metastasis (MLNM). Our aim was to determine if appropriate patients had been selected and to compare morbidity.

Method

Retrospective analysis was undertaken of 299 men who underwent robotic radical prostatectomy at our institution between January 2013 and December 2015. Patients were subdivided into 2 groups those who had undergone EPLND (tissue excised from obturator, internal and external iliac region +/- common iliac region) and those that hadn’t (NOLND). Data was collected on demographics, calculated Briganti score, duration of surgery, LN yield, and complications. Results were analysed using the student-t test or chi squared test on spssv23 (p= <0.05 was considered significant).

Results

Eighty Eight men (29.4%) had EPLND; 66 (86.4%) had bilateral EPLND with average LN yield 15.8 (range 4-42) and 12 (13.6%) had unilateral EPLND, average LN yield 6.17 (range 1-9). Two hundred and eleven men had NOLND. Univariate analysis showed statistically significant difference between age at surgery, calculated Briganti score, operating time (mins) and length of hospital stay (p=0.001, p=0.000, p=0.001, p=0.048 respectively). No difference in blood loss (p= 0.872). Twenty-nine patients (6 EPLND vs 13 NOLND) (14.1%) had a post-operative complication none were Clavien-Dindo grade 3 or above (p=0.799).

Conclusion

EPLND will continue to provide therapeutic and diagnostic benefit for suitable patients at risk MLNM. We have shown there is no significant difference in morbidity or mortality contradicting previous studies.