Higher nodal yield with robot-assisted pelvic lymph node dissection for bladder cancer compared to laparoscopic dissection: implications for more accurate staging.

Autor:	Arora A; Department of Urology, Institut Mutualiste Montsouris, Paris, France.; Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India., Pugliesi F; Department of Urology, Institut Mutualiste Montsouris, Paris, France.; Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, Brazil., Zugail AS; Department of Urology, Institut Mutualiste Montsouris, Paris, France.; Department of Urology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia., Moschini M; Department of Urology, Institut Mutualiste Montsouris, Paris, France.; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland., Pazeto C; Department of Urology, Institut Mutualiste Montsouris, Paris, France., Macek P; Department of Urology, Institut Mutualiste Montsouris, Paris, France., Stabile A; Department of Urology, Institut Mutualiste Montsouris, Paris, France.; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Lanz C; Department of Urology, Institut Mutualiste Montsouris, Paris, France., Cathala N; Department of Urology, Institut Mutualiste Montsouris, Paris, France., Bennamoun M; Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France., Sanchez-Salas R; Department of Urology, Institut Mutualiste Montsouris, Paris, France., Cathelineau X; Department of Urology, Institut Mutualiste Montsouris, Paris, France.
Jazyk:	angličtina
Zdroj:	Arab journal of urology [Arab J Urol] 2020 Oct 01; Vol. 19 (1), pp. 92-97. Date of Electronic Publication: 2020 Oct 01.
DOI:	10.1080/2090598X.2020.1824570
Abstrakt:	Objectives: To compare the lymph node (LN) yield and adequacy of laparoscopic pelvic lymph node dissection (L-PLND) and robot-assisted PLND (R-PLND), as PLND is a fundamental component of radical cystectomy (RC) for bladder cancer (BCa), where a positive status is the most powerful predictor of disease recurrence and survival. Patents and Methods: We retrospectively reviewed patients undergoing RC with PLND for BCa from January 2007 to July 2019 and grouped them in to L- and R-PLND. Until 2011, patients underwent a standard PLND (S-PLND) with the cranial limit as bifurcation of common iliac artery. Since 2012, an extended PLND (E-PLND) up to aortic bifurcation has been performed. An adequate S- and E-PLND were defined as those that yielded at least 10 and 16 LNs, respectively. The groups were compared for LN yield and adequacy of PLND. Results: During the study period, 305 patients underwent minimally invasive RC in our centre, of which 274 (89.8%) underwent a concomitant PLND (98 L-PLND, 176 R-PLND). R-PLND resulted in a significantly greater median LN yield compared to L-PLND, both in the S-PLND (16 vs 11, P < 0.001) and the E-PLND (19 vs 14, P < 0.001) eras. Also, a significantly higher proportion of patients in the R-PLND group had an adequate PLND compared to the L-PLND group. Surgical approach to PLND (R- vs L-PLND) was the only variable that was significantly associated with an adequate PLND on both univariable (odds ratio [OR] 1.860, 95% confidence interval [CI] 1.114-3.105; P = 0.01) and multivariable (OR 2.109, 95% CI 1.222-3.641; P = 0.007) analyses. Conclusion: R-PLND leads to a higher LN yield and a greater probability of an adequate PLND compared to L-PLND for both standard and extended templates. Therefore, the robot-assisted approach would lead to more accurate staging following RC with PLND. Competing Interests: The authors report no conflict of interest. (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)
Databáze:	MEDLINE
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