Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPLESTINGI, J. F. P.SALAS, R. S.YOSHIOKA, K.COELHO, R. F.2023-12-042023-12-042022Lestingi, J. F. P.; Salas, R. S.; Yoshioka, K.; Coelho, R. F.. Lymphadenectomy in Prostate Cancer: Technique and Outcomes. In: . Robotic Urologic Surgery: Third Edition: SPRINGER INTERNATIONAL PUBLISHING, 2022. p.305-349.978-303100363-9; 978-303100362-2https://observatorio.fm.usp.br/handle/OPI/57246Despite recent advances in imaging, pelvic lymph node dissection (PLND) remains the gold standard modality for nodal staging in prostate cancer (PCa) patients. There remains significant debate about PLND: the odds of finding positive pelvic lymph nodes are proportional to the extent of the PLND; however, the therapeutic benefits of more extensive PLND remain an area of controversy, besides the increasing number of surgical risks. This chapter will review indications, techniques, and results of extended pelvic lymphadenectomy (ePLND) in the surgical treatment of PCa patients. Two recent randomized controlled trials comparing extended to limited PLND have not demonstrated differences in early biochemical recurrence. Limited lymphadenectomy significantly underestimates the actual incidence of lymph node metastasis and should no longer be performed for staging. EPLND is currently the gold standard in lymph node staging. It should be reserved for patients at higher risk of lymph node invasion. The oncological role of ePLND is not defined. It can help patients directly (up to two positive lymph nodes), indirectly (select for adjuvant treatments), or may benefit patients with ISUP Gleason Grade in biopsy 3-5. EPLND is also associated with significantly worse intra- and postoperative non-oncological outcomes, such as bleeding, lymphocele, and increased surgical time. The oncological role of salvage lymphadenectomy also is not clear. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.engrestrictedAccessLymphatic metastasisPelvic lymph node dissectionPrognosisProstate cancerRobotic-assisted lymphadenectomybookPartCopyright SPRINGER INTERNATIONAL PUBLISHING10.1007/978-3-031-00363-9_27