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.

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 13 LNY group (P = 0.036). Median (IQR) console time was significantly different, at 120 min (95-137) for the ≥13 LNY group vs 100 min (85-120) for the <13 LNY group (P = 0.04). Among patients who fitted the inclusion criteria for functional outcomes (n = 561), 55.2% (16 of 29) with ≥20 LNs removed recovered potency at a median follow-up of 6 months postoperatively vs 70% of patients with