To efficiently remove all recurrent lymph nodes(rLNs)and minimize complications,we developed a combination approach that consisted of 68Gallium prostate-specific membrane antigen(PSMA)ligand positron emission tomography(PET)/computed tomography(CT)and integrated indocyanine green(ICG)-guided salvage lymph node dissection(sLND)for rLNs after radical prostatectomy(RP).Nineteen patients were enrolled to receive such treatment.68Ga-PSMA ligand PET/CT was used to identify rLNs,and 5 mg of ICG was injected into the space between the rectum and bladder before surgery.Fluorescent laparoscopy was used to perform sLND.While extensive LN dissection was performed at level I,another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal,and laparoscopy was introduced to intensively target stained LNs along levels Ⅰ and Ⅱ,specifically around suspicious LNs,with 68Ga-PSMA ligand PET/CT.Next,both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels Ⅲ and Ⅳ.In total,pathological analysis confirmed that 42 nodes were rLNs.Among 145 positive LNs stained with ICG,24 suspicious LNs identified with 68Ga-PSMA ligand PET/CT were included.The sensitivity and specificity of 68Ga-PSMA ligand PET/CT for detecting rLNs were 42.9％and 96.6％,respectively.For ICG,the sensitivity was 92.8％and the specificity was 39.1％.At a median follow-up of 15(interquartile range[IQR]:6-31)months,15 patients experienced complete biochemical remission(BR,prostate-specific antigen[PSA]＜0.2 ng ml-1),and 4 patients had a decline in the PSA level,but it remained＞0.2 ng ml-1.Therefore,\"Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.