Objectives
To evaluate the morbidity of the different surgical approaches for pelvic lymph node dissection (PLND), to evaluate the influence of morbidity on radiotherapy (RT) planning and to evaluate a possible therapeutic effect of the PLND itself.
Methods
From 2000-2016, 228 patients received staging PLND before primary RT in a single tertiary care centre. Nine patients were excluded for the evaluation of morbidity. Fifty patients were operated in an open approach, 96 laparoscopic and 73 robot-assisted (RA). Clavien-Dindo classification was used for evaluating complications. Predictors of biochemical recurrence (BCR), clinical relapse (CR), cancer-specific survival (CSS) and overall survival (OS) were evaluated by regression analyses to determine a possible therapeutic effect.
Results
Minimal invasive surgery (laparoscopic or RA) caused five times less major complications (22% versus 4.3%, p=0.001) and a median 3 days shorter hospital stay (5d versus 2d, p<0.001). There was less blood loss in the RA compared to the laparoscopic group (p=0.015). Major complications resulted in a delayed (23 days) RT start but no oncological effect was seen. Independent oncological predictors were the number of positive nodes (BCR/CR/CSS/OS), a lower age (CR), a higher level of initial prostate specific antigen (PSA) (BCR/CR) and post RT PSA (BCR).
Conclusions
Minimal invasive surgery can diminish major complications which delay RT start. Nodal staging proved to be of importance for prognosis but no significant therapeutic effect was seen of performing PLND as such.