Assessment of required nodal yield in a high risk cohort undergoing extended pelvic lymphadenectomy in robotic-assisted radical prostatectomy and its impact on functional outcomes

What's known on the subject? and What does the study add? Although high risk prostate cancer patients are most vulnerable to lymph node invasion, the definition of an extended pelvic lymph node dissection (PLND) for this cohort has remained vague. Additionally, there have been compelling data in the rectal cancer literature relating erectile dysfunction to the extent of PLND. Because of the similarities of the dissection templates, we investigated the impact of an extended PLND on urinary and sexual function. In the present study, we were able to determine a minimal lymph node yield necessary for accurate staging of high risk patients. Expanding the analysis to our entire cohort, we found worse potency outcomes in patients with an extended PLND, demonstrating that extended PLND may be counterproductive to the aims of nerve sparing in a lower risk population. Objectives To establish a minimal lymph node yield (LNY) necessary for accurate staging in a high risk cohort, since no consensus exists as to the optimal extent of pelvic lymph node dissection (PLND) needed during radical prostatectomy in high risk patients. To investigate the impact of an extended PLND on urinary and sexual function. Patients and Methods In all, 760 men underwent robotic-assisted radical prostatectomy from January 2010 to May 2011 by a single surgeon (AKT). Low and intermediate risk groups (as defined by the D'Amico classification) underwent a minimum of a limited PLND (obturator/external iliac packets) and high risk patients underwent an extended PLND (as limited plus hypogastric, triangle of Marcille and common iliac packets up to the level of the ureteric crossing). In order to analyse LNY for staging purposes, the high risk group (n = 82) was subdivided into patients with ≥13 LNY vs