186 Indication and extension of pelvic lymph node dissection during robot-assisted radical prostatectomy. An analysis of 5 institutions

Suardi N.1, Haese A.2, Ficarra V.3, Govorov A.4, Buffi N.M.1, Walz J.5, Rocco B.6, Borghesi M.7, Mottrie A.7, SteuberT.2, Guazzoni G.1, Pushkar D.4, Van Der Poel H.8, The Young Academic Urologist-robotic EAU section1Urological Research Institute, University Vita-Salute San Raffaele, Dept. of Urology, Milan, Italy, 2University ofHamburg Eppendorf, Dept. of Urology, Hamburg, Germany, 3University of Padua, Dept. of Urology, Padua, Italy,4University of Moscow, Dept. of Urology, Moscow, Russia, 5Institut Paoli-Calmettes, Dept. of Urology, Marseille,France, 6University of Milan, Dept. of Urology, Milan, Italy, 7O.L.V. Clinic, Dept. of Urology, Aalst, Belgium, 8Universityof Amsterdam, Dept. of Urology, Amsterdam, The NetherlandsINTRODUCTION & OBJECTIVES: Several reports have shown that patients submitted to minimally invasive radicalprostatectomy have a lower chance to be submitted to pelvic lymph node dissection (LND), irrespective of thecharacteristics of the disease. We aimed at evaluating the rate and the extension of LND in patients submitted to robotassistedradical prostatectomy (RARP) in different European institutions.MATERIAL & METHODS: We merged the prospectively collected databases of consecutive patients submitted toRARP in different European institutions between 2005 and 2012. All patients had complete pre-operative (age, PSA,clinical stage, biopsy Gleason score) and pathological information regarding the occurrence of LND and the number oflymph nodes. Patients were stratified according to pre-operative risk group: : low (PSA < 10 ng/ml, clinical stage T1cand Gleason score 6 or less), high (PSA >20 ng/ml, clinical stage T3 or Gleason score 8-10) and intermediate (all theremaining). ANOVA and Chi-square analyses evaluated the rate and the extent of LND across different institutions foreach risk group of pts. Logistic regression analyses targeted the multivariable association between number of nodesremoved and presence on nodal metastases.RESULTS: Complete data were available for 2985 pts. from 5 institutions. Mean and median PSA value at diagnosiswas 9.18 and 7.0 ng/ml, respectively. Clinical stage was T1, T2 and T3 in 60.8, 35.1 and 4.0% of pts., respectively.Biopsy Gleason sum was 2-6, 7 and 8-10 in 58.4, 32.9 and 8.8% of pts., respectively. Risk groups: low: 31.6%,intermediate: 52.4%, high: 16.0%. Overall, a LND was performed in 1777 pts. (59.7%; 34.5% of low-risk, 65.0% ofintermediate risk and in 91.2% of high risk pts.). These rates were different across institutions: 5.0-41.4% in low-risk(p<0.001), 31.3-81.4% in intermediate risk (p<0.001) and 84.6-96.4% in high-risk pts. (p=0.06), respectively. Mean andmedian number of nodes removed was 10.8 and 10, respectively. These figures were 9.3 (8.9-12.2; p=0.61), 10.2 (9.1-12.3; p<0.001) and 13.4 (9.8-14.8; p=0.18) for low, intermediate and high risk patients, respectively. Overall, 122 pts.(4.1%, range:1.0-13.1%) had nodal metastases at histological examination, which represents 6.9% (range:2.9-19.5%,p<0.001) of pts. submitted to LND. The percent of patients with nodal metastases was 0.3 (0-3.2; p=0.04), 3.2 (1.6-8.0;p=0.003) and 14.4 (0-24.2; p=0.01)% in low, intermediate and high risk patients, respectively. At logistic regressionanalyses, the number of nodes represented an independent predictor of nodal metastases in all pts.186 Indication and extension of pelvic lymph node dissection during robotassistedradical prostatectomy. An analysis of 5 institutionsEur Urol Suppl 2013;12;e186