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Lymp Nodes not removed during robotic surgery

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Posted 4/20/2008 12:00 PM (GMT 0)
Let me first thank you all at Healing Well. What a bunch of great guys you are all !!!. I log on at every opportunity I get, to improve my knowledge of this dreaded disease which we should all conquer.

I now realise that my lymph nodes were not removed during the robotic surgery,although Dr Walsh's book (chapter 8) says it is better to remove them for ALL patients during surgery what ever be the risk profile of the patient. I understand that the chances of lymph node involvement are small for my type of disease; nevertheless if I had the knowledge then I would have asked it to be removed during surgery. Has any of you had the lymph nodes not removed during robotic surgery ? Is it possible to have the lymph nodes removed after the surgery;is it a good idea, what are the other options if not surgery? Any opinion would be much appreciated.

My first 3 month psa test is coming up, apprehensive.
Posted 4/20/2008 1:15 PM (GMT 0)
I had a lymph node disection and the way it was explained to me was because of the aggression of the cancer. I am a gleason 9, my understanding and trust me I am no expert is if the doctor determines that it is unlikely of any spread the usually opt not to do the lymph nodes. I think your doctor took the right approach. After my disection I developed a post op hematoma due to a leaking from the lymph area not healing well and I had to have that drained. So I am sure there are some inherent dangers involved. Keep the hope and dreams alive and well and please keep us posted as to how your healing progresses.

peace and grace
Dale
Posted 4/20/2008 7:49 PM (GMT 0)
Remember, Walsh's book is now considered old - there have been newer editions, but info like this might not be the latest thinking. There have been several studies that now say that their removal is not that important for the low risk guys. Talk to your doc or get a second opinion. The stress you're experiencing from this is not good for you either. You deserve to get to a place of peace of mind.
Paul
Posted 4/21/2008 5:24 AM (GMT 0)
I had the DaVinci procedure last August. One lymph node was removed during surgery. The prostate together with the lymph node was checked immediately before surgery was finalized and it was determined surgical margins and the lymph node were clear. I can only assume this was why no further nodes were removed in my case.
Bill
Posted 4/21/2008 11:04 AM (GMT 0)
Thank you Dale,Paul & Bill. Your comments are much appreciated. Sometimes things get you down for no reason; and responses from others help a lot. I will ask the surgeon at the next meeting about more info on my nodes. john
Posted 4/21/2008 6:02 PM (GMT 0)
Similar to your case (from age 48, PSA 3.1, Gleason 3+3=6, T2c to surgery time and improvement of continence!), my lymp nodes were not removed during the surgery (Laparoscopic). My surgeon said it was not necessary since the cancer was in early stage, not yet agressive and contained. So far so good, 1st post op PSA is undetectable. Good luck on your upcoming PSA test.
Posted 4/21/2008 8:12 PM (GMT 0)
I also had DaVinci without lymph node removal... so far so good, my 3 month PSA was undetectable. Sounds like they leave them fairly often when it's caught early. Have confidence in their assessment! Hang in there and good luck!
Posted 4/21/2008 8:55 PM (GMT 0)

This is my first post.  My story is very, very similar to positivelife's....see my info below.

My doctor also did not take out any lymph nodes.  I was concerned as well, but from what I understand, that is not necessary for our situation.

Good luck to all on our jorney.

Posted 4/21/2008 9:07 PM (GMT 0)
Someone correct me if I am wrong, but I believe that one of the ONLY negatives with the Da Vinci is that often times surgeons are not able to get the lymph nodes for biopsy during surgery. When my father had met with the his original urologist, he wanted to do an open prostatectomy because he wanted to biopsy the lymph nodes and didn't feel he would be able to if he did the Da Vinci. (He did not have very many Da Vinci's under this belt) However, we decided to go with a more experienced surgeon and he in fact was able to get a few lymph nodes. I was under the impression that it depended on the surgeon, anatomy etc. as to whether or not they could biopsy the nodes.
Hopefully, your PSA's will come back undetectable and you will not have to worry about it :) Try to stay positive in the meantime. Best wishes!
Posted 4/21/2008 9:30 PM (GMT 0)

I had RRP and along with the prostate, had two lymph nodes removed (left and right) -- is that all there are, or are there more? They turned out to be free of cancer. I was Gleason 4+9=9 pre-op and downgraded to 4+4=8 post=op, with the cancer confined to  the prostate.

Positivelife, as you would need another operation to remove your lymph nodes now, I don't think that is something you should seriously consider -- unless of course your doc thinks otherwise :-)

Posted 4/22/2008 3:20 PM (GMT 0)
My urologist did not do a bone scan prior to open surgery, as some do, but did remove a couple of lymph nodes during the procedure on the outside chance that any cancer had spread outside the prostate.  I'm glad he did for my own peace of mind. 
Posted 4/22/2008 10:56 PM (GMT 0)
My surgeon also removed one right and one left lymph node to rule out spread to local nodes, I am glad he did, for my peace of mind, even though I had little total involvement. Maybe ad DD stated, it was impractical to get to them, there is a lot going on in the lower pelvic cavity, and maybe the risk of damage to nerves and surrounding structures just was not worth it, trust his expertise and have confidence that he acted in your best interest.
Posted 5/1/2008 10:33 PM (GMT 0)
Received the first post op Psa results <.1 What a relief !!! Thanks for your replies TimG,Piano,Dotingdaughter,jrponalameda,ct, lungman and stuckintraffic.

For all those intending surgery - please remember to ask the surgeon about removal of lymph nodes. In my opinion, surgery is one chance to get the beast out;why not take the lymph nodes out as well? The risk of later spread to lymph nodes is only 1% for the lower gleason grade, organ confined, margins clear surgery; nevertheless it is still a risk !!

I get the impression that most of the robotic procedures does not touch/remove the lymph nodes whilst the open surgery does. Is this a distinct disadvantage of the robotic surgery process;difficult to manoeuvre the robotic arms around in the pelvic area ? Comments by those who had the surgery (whether open or robotic) would be most welcome.
Posted 5/1/2008 11:06 PM (GMT 0)

Positivelife,

I am very similar to you in regards to this.  My family urologist who wanted to do open said he would take it all and save my life.  He said he would take lymph nodes, cut the nerves way back?,and cut the margins wide?  My biopsy seemed to indicate we were early so I got two more opinions from major universities.  Both said totally not necassary,BASED ON THE BIOPSY, which is what everything is based on.  I still dont know why they cant take the prostate out do a quick look at the margins, sample the lymphs and correct if necassary or close.  I have never got a good answer to this question.  Seems like a Lab procedure to me.

Frank

Posted 5/1/2008 11:17 PM (GMT 0)
Frank, not sure if I am following your sentences correctly, but some urologists will examine the lymph nodes and if cancer is found, close the patient back up without completing the surgery.  This is a fairly common practice.

Posted 5/1/2008 11:24 PM (GMT 0)
DanmanBob, as I understand examining of the lymph nodes is done routinely for all open surgery but not for Robotic surgery ?
Posted 5/2/2008 12:30 AM (GMT 0)
Not in my case. 10 lymph nodes were removed and biopsied. I have noticed this varies from doctor to doctor not by technique. My doctor takes the nodes as part of his daVinci procedure.

Tony
Posted 5/2/2008 3:22 AM (GMT 0)

Hi Guys,

Yes this is exactly my interest.  There does not seem to be consistant approach with these lymph nodes.  And those darn margins too.  However I cant remember too many if any on this site that had predicted early cancer where lymph node involvement was found.. In my case I wanted then to look at that prostate, ink it real good and do a preliminary look.

I guess I am just getting the jitters a little .  Got my appointment with the oncologist May 9th..

Posted 5/2/2008 1:42 PM (GMT 0)

positivelife,

As Frank and TC stated, it varies by doctor and in many cases by the pathology from the pre-surgery biopsy.  When an unaggressive cancer is determined....I do not know the parameters for making the detemination....SOME doctors do not check lymph nodes because the chance of cancer having already spread is considered to be nil.  For more aggressive/advanced cancer, lymph nodes are checked.  Again, it varies by doctor.

Posted 5/10/2008 12:15 PM (GMT 0)
Thanks Dale(livinadream) for starting another topic on Lymph nodes. Thanks to all who made their valuable advice and opinions on this thread on lymph nodes.

For those of us coming to this forum and asking advice on surgery, I think we should advice them strongly to have a good discussion with the surgeon about removal of the lymph nodes. The main reasons are these:

1)Prostectomy is a major surgery, a one time chance of getting the cancer out;why not take the lymph nodes out as well at the same time ? The risk of later spread to lymph nodes is only 1% for the lower gleason grade, organ confined, margins clear successful surgery; nevertheless IT IS STILL A RISK !! You wouldn't want to have a organ confined,clear margin surgery, live with all the side effects, have 0 psa's but still have the possibility of cancer at lymph nodes years down the line.

2)The surgeon decides about lymph nodes mainly based on biopsy results and scans. I read somewhere that lymph node involvement picked up on scans is only 15-30%. As far as the reliability of biopsies, we all know that most often the post op pathology shows higher Gleason scores and higher tumour volume than pre op biopsies and clear margins are quite a lottery. Also the biopsy may say no lympho vascular invasion but the post op pathology may say lympho vascular invasion is there. May be a 30 needle biopsy could help better on deciding about lymph nodes but some people say there is the risk of microscopic spread with such an extensive needling of the prostate.

3)Taking the lymph nodes out during the robotic surgery is an extra 15- 20 mins of operating time. A cynic would say that the less time spent on operations,the more operations that can be done,the more money is there to be had for the medical establishment.

We have to win this battle with prostate cancer. One way is that the new members who are going for a major surgery has all the information beforehand so that they can hope for as clear a cure route as possible. I may may be splitting hairs to accentuate a line of thought, or i could even be incorrect in my reasoning; but opinions from our experienced members would only provide more info for new members seeking advice about surgery.
Posted 5/10/2008 12:33 PM (GMT 0)
this has been a great thread. It seems to me like there is no good reason not to do a lymph node disection as proper protocol during surgery. It would certainly give some men a peace of mind. We just have to keep educating ourselves and take control of our health.

peace and love to all
dale
Posted 5/10/2008 7:14 PM (GMT 0)
I just spoke with my surgeon at Ohio State and he said they always remove the lymph nodes.  Standard practice during any RP open or robotic.  However, he only does robitic.

Posted 5/10/2008 7:42 PM (GMT 0)
My surgeon removed and sent some of the lymph nodes to be analyzed during the operation. (I get they went out for coffee till the report came back.) The result was negative so they proceeded with the surgery.
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