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Recently, the en-bloc ePLND has been proposed but no studies reported on the standardization of the technique. The aim of the study is to describe different standardized en-bloc ePLND, the antegrade and the retrograde ePLND, and to compare their surgical and oncological outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials &amp; Methods<\/jats:title>\n                <jats:p>From January 2018 to September 2019, all patients subjected to RARP plus ePLND by one single surgeon were enrolled. ePLND was performed in a retrograde fashion by starting laterally to the medial umbilical ligament from the internal inguinal ring proceeding towards the ureter, or in an antegrade way by starting from the ureter at its crossing with the common iliac artery and proceeding towards the femoral canal. Patients\u2019 demographic data, clinical and surgical data were collected. Each en-bloc ePLND was categorized as \u201cefficient\u201d or \u201cinefficient\u201d by the operator, as surrogate of surgeon\u2019s satisfaction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Antegrade and retrograde ePLND were performed in 41\/105 (group A) and 64\/105 (group R) patients, respectively. The two groups (A vs R) had similar median (IQR) number of lymph nodes retrieved [20 (16.25\u201331.5) vs 19 (15\u201326.25); <jats:italic>p<\/jats:italic>\u2009=\u20090.18], ePLND time [33.5 (29.5\u201338.5) min vs 33.5 (26.5\u201337.5) min; <jats:italic>p<\/jats:italic>\u2009=\u20090.4] and post-operative complications [8\/41 (19.5%) vs 9\/64 (14.1%); <jats:italic>p<\/jats:italic>\u2009=\u20090.61]. In group A, 3\/41 (7.3%) clinically significant lymphoceles were reported, while 1\/64 (1.6%) in group R (<jats:italic>p<\/jats:italic>\u2009=\u20090.3). 33\/41 (80.5%) and 28\/64 (44%) procedures were scored as efficient 59 in group A and R, respectively (<jats:italic>p<\/jats:italic>\u2009=\u20090.01). On multivariate regression, only BMI (B\u2009=\u20090.93; 95% CI 0.29\u20131.56; <jats:italic>p<\/jats:italic>\u2009=\u20090.005) was associated with a longer ePLND time.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The study indicates that antegrade and retrograde en-bloc extended pelvic lymph node dissection (ePLND) have comparable surgical and oncologic outcomes, supporting the importance of standardizing the procedure rather than focusing on the direction. Although both techniques aligned with current evidence regarding lymph node invasion and complications, the antegrade approach was subjectively perceived as safer due to early isolation of critical anatomical landmarks. Encouragement for the use of en-bloc ePLND, regardless of direction, is emphasized to improve prostate cancer staging accuracy and procedural standardization.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12894-024-01448-1","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T13:01:44Z","timestamp":1711026104000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Extended pelvic lymph node dissection during robotic prostatectomy: antegrade versus retrograde technique"],"prefix":"10.1186","volume":"24","author":[{"given":"Giancarlo","family":"Albo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Gallioli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Ripa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"De Lorenzis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Boeri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Bebi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Rocchini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Longo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano Paolo","family":"Zanetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Turetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Piccoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Montanari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"1448_CR1","first-page":"67","volume":"22","author":"RH Flocks","year":"1958","unstructured":"Flocks RH, Culp D, Porto R. 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Ethical approval was secured from the Ethical Committee of the Foundation IRCCS Ca\u2019 Granda \u2013 Ospedale Maggiore Policlinico (number of the certification n 0029354). All patients signed and provided an informed consent agreeing to share their own anonymous information for future studies.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"64"}}