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Minerva Chirurgica 2019 February;74(1):88-96

DOI: 10.23736/S0026-4733.18.07780-5


lingua: Inglese

Robot-assisted extended lymphadenectomy in prostate cancer

Stavros I. TYRITZIS 1, 2 , Nikolaos KALAMPOKIS 3, Nikolaos GRIVAS 3, 4, Henk van der POEL 4, N. Peter WIKLUND 1

1 Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; 2 Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece; 3 Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece; 4 Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital Amsterdam, Amsterdam, The Netherlands

INTRODUCTION: The extent of lymph node dissection (LND) and its potential survival benefit are still a matter of debate. Aim of our review was to summarize the latest literature data regarding the surgical templates, the potential oncological benefits, the functional outcomes and the complications of extended lymph node dissection (eLND) during robot-assisted radical prostatectomy (RARP).
EVIDENCE ACQUISITION: We systematically reviewed all relevant studies using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) guidelines.
EVIDENCE SYNTHESIS: A narrative synthesis of all relevant publications on surgical templates, complications, oncological and functional outcomes of robot assisted eLND was undertaken.
CONCLUSIONS: A great deal of evidence supports that an extended template of LND is not only technically feasible but also safe in the context of RARP. It is really promising that in the era of minimally invasive surgery, parameters like the lymph node yield and the detection rates of positive lymph nodes during LND have become highly comparable with open series. The extended approach has already proved its benefits in terms of proper patient staging but more studies are needed with regard to functional outcomes and oncological benefits of this procedure.

KEY WORDS: Prostatic neoplasms - Prostatectomy - Lymph nodes - Lymph node excision - Complications - Recurrence

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