V08-05: Salvage Robot-Assisted Retroperitoneal Lymphadenectomy for Prostate Cancer Nodal Recurrence Only detected by 68Ga-PSMA PET CT: technical aspects and results?
Positron emission tomography (PET-CT) with 68Ga-Prostatic Specific Membrane Antigen (PSMA) represents the imaging study of choice to identify patients with potential lymph node metastases. Previous data revealed favorable cancer control rates after Salvage Lymph Node Dissection (sLND) in patients with primary prostate cancer lymph node recurrence. The aim of this video is to provide the detailed technique description of Salvage Robot-Assisted Retroperitoneal Lymphadenectomy (sRLND) along with a single institution initial results.
We selected 10 consecutive patients with biochemical recurrence after primary radical prostatectomy. Prostate cancer lymph node only recurrence was defined by Positron emission tomography (PET-CT) with 68Ga-Prostatic Specific Membrane Antigen (PSMA) uptake and then submitted to sRLND performed by a single surgeon 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, which remain skeletonized, associated with clip-ligated distal lymphatic vessels and mono and bipolar hemostasis are used.
Positive lymph nodes were detected in 8 (80%) patients after sRLND. Mean number of lymph nodes retrieved 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%. 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.
Preliminary results reveals sRLND to be a safe and feasible treatment option for lymph node only recurrence. Salvage lymphadenectomy poses to improve oncological outcomes and to achieve immediate BCR in selected patients. Randomized controlled trials with longer follow up is needed to address long term results.