Robotic Salvage Lymph Node Dissection in Recurrent Prostate Cancer: Lessons Learned from 68 Cases and Implications for Future Clinical Management
2021; Lippincott Williams & Wilkins; Volume: 206; Issue: 1 Linguagem: Inglês
10.1097/ju.0000000000001697
ISSN1527-3792
AutoresJohannes Linxweiler, J.N. Sprenk, Katerina Cascetta, Alexej Pryalukhin, Sebastian Hölters, Philip Zeuschner, Alessandro Nini, Zaid Al-Kailani, Samer Ezziddin, Rainer M. Bohle, Peter Fries, Carsten‐Henning Ohlmann, Julia Heinzelbecker, Stefan Siemer, Michael Stöckle, Kerstin Junker, Matthias Saar,
Tópico(s)Urologic and reproductive health conditions
ResumoNo AccessJournal of UrologyAdult Urology1 Jul 2021Robotic Salvage Lymph Node Dissection in Recurrent Prostate Cancer: Lessons Learned from 68 Cases and Implications for Future Clinical Management Johannes Linxweiler, Jan Sprenk, Katerina Cascetta, Alexej Pryalukhin, Sebastian Hölters, Philip Zeuschner, Alessandro Nini, Zaid Al-Kailani, Samer Ezziddin, Rainer M. Bohle, Peter Fries, Carsten H. Ohlmann, Julia Heinzelbecker, Stefan Siemer, Michael Stöckle, Kerstin Junker, and Matthias Saar Johannes LinxweilerJohannes Linxweiler *Correspondence: Universitätsklinikum des Saarlandes, Klinik für Urologie und Kinderurologie, Kirrberger Straße 100, Gebäude 6, 66424Homburg/Saar, Germany telephone: +49-68411624700; FAX: +49-68411624795; E-mail Address: [email protected] Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author , Jan SprenkJan Sprenk Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author , Katerina CascettaKaterina Cascetta Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author , Alexej PryalukhinAlexej Pryalukhin Department of General and Surgical Pathology, Saarland University, Homburg/Saar, Germany Department of Pathology, Landesklinikum Wiener Neustadt, Wien, Austria More articles by this author , Sebastian HöltersSebastian Hölters Department of Urology, Saarland University, Homburg/Saar, Germany Ingenieurbüro für Gesundheitswesen GmbH, Leipzig, Germany More articles by this author , Philip ZeuschnerPhilip Zeuschner Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author , Alessandro NiniAlessandro Nini Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author , Zaid Al-KailaniZaid Al-Kailani Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author , Samer EzziddinSamer Ezziddin Department of Nuclear Medicine, Saarland University, Homburg/Saar, Germany More articles by this author , Rainer M. BohleRainer M. Bohle Department of General and Surgical Pathology, Saarland University, Homburg/Saar, Germany More articles by this author , Peter FriesPeter Fries Clinic of Diagnostic and Interventional Radiology, Saarland University, Homburg/Saar, Germany More articles by this author , Carsten H. OhlmannCarsten H. Ohlmann Department of Urology, Saarland University, Homburg/Saar, Germany Department of Urology, Malteser Hospital Seliger Gerhard, Bonn, Germany More articles by this author , Julia HeinzelbeckerJulia Heinzelbecker Department of Urology, Saarland University, Homburg/Saar, Germany Financial interest and/or other relationship with Roche, Boston Scientific and EISAI. More articles by this author , Stefan SiemerStefan Siemer Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author , Michael StöckleMichael Stöckle Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author , Kerstin JunkerKerstin Junker Department of Urology, Saarland University, Homburg/Saar, Germany Equal study contribution. More articles by this author , and Matthias SaarMatthias Saar Department of Urology, Saarland University, Homburg/Saar, Germany Equal study contribution. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001697AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Salvage lymph node dissection is a rescue treatment for patients with nodal recurrence after radical prostatectomy. Very limited data are available on robotic salvage lymph node dissection. Our purpose was to investigate perioperative and oncological outcomes of robotic salvage lymph node dissection in a large monocentric series. Materials and Methods: Perioperative data, complications within 30 days after surgery and oncological outcomes as assessed by histology, prostate specific antigen changes, prostate specific antigen nadir after salvage lymph node dissection, and time to further therapy were analyzed. To identify predictive factors for oncological outcome, Kaplan-Meier and Cox-regression analyses were performed. For cases with a mismatch between preoperative positron emission tomography/computed tomography and the number of histologically positive lymph nodes, prostate specific membrane antigen immunohistochemistry was performed on removed lymph nodes. Results: A total of 68 patients underwent robotic salvage lymph node dissection with a median operation time of 126 minutes, a blood loss of 50 ml, and a length of stay of 4 days. No major complications (>Clavien 3) occurred. Median followup was 12.1 months. Median time to further therapy was 12.4 months, 37% of patients experienced complete biochemical response (prostate specific antigen 1 year in 3 cases. Lower preoperative prostate specific antigen, longer time between radical prostatectomy and salvage lymph node dissection, preoperative prostate specific membrane antigen positron emission tomography/computed tomography and complete biochemical response after salvage lymph node dissection were significant predictors of longer therapy-free survival (all p <0.005). Prostate specific membrane antigen immunohistochemistry revealed that prostate specific membrane antigen positron emission tomography/computed tomography tends to miss small lymph node metastases 5 mm. References 1. : MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med 2020; 382: 917. 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Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue 1July 2021Page: 88-96Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsrobotic surgical procedurespositron emission tomography computed tomographyrecurrencelymph node excisionMetricsAuthor Information Johannes Linxweiler Department of Urology, Saarland University, Homburg/Saar, Germany *Correspondence: Universitätsklinikum des Saarlandes, Klinik für Urologie und Kinderurologie, Kirrberger Straße 100, Gebäude 6, 66424Homburg/Saar, Germany telephone: +49-68411624700; FAX: +49-68411624795; E-mail Address: [email protected] More articles by this author Jan Sprenk Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author Katerina Cascetta Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author Alexej Pryalukhin Department of General and Surgical Pathology, Saarland University, Homburg/Saar, Germany Department of Pathology, Landesklinikum Wiener Neustadt, Wien, Austria More articles by this author Sebastian Hölters Department of Urology, Saarland University, Homburg/Saar, Germany Ingenieurbüro für Gesundheitswesen GmbH, Leipzig, Germany More articles by this author Philip Zeuschner Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author Alessandro Nini Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author Zaid Al-Kailani Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author Samer Ezziddin Department of Nuclear Medicine, Saarland University, Homburg/Saar, Germany More articles by this author Rainer M. Bohle Department of General and Surgical Pathology, Saarland University, Homburg/Saar, Germany More articles by this author Peter Fries Clinic of Diagnostic and Interventional Radiology, Saarland University, Homburg/Saar, Germany More articles by this author Carsten H. Ohlmann Department of Urology, Saarland University, Homburg/Saar, Germany Department of Urology, Malteser Hospital Seliger Gerhard, Bonn, Germany More articles by this author Julia Heinzelbecker Department of Urology, Saarland University, Homburg/Saar, Germany Financial interest and/or other relationship with Roche, Boston Scientific and EISAI. More articles by this author Stefan Siemer Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author Michael Stöckle Department of Urology, Saarland University, Homburg/Saar, Germany More articles by this author Kerstin Junker Department of Urology, Saarland University, Homburg/Saar, Germany Equal study contribution. More articles by this author Matthias Saar Department of Urology, Saarland University, Homburg/Saar, Germany Equal study contribution. More articles by this author Expand All Advertisement PDF downloadLoading ...
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