Background: Salvage lymph node dissection (sLND) has been proposed to improve oncologic outcomes in nodal recurrence after radical prostatectomy (RP). We aimed at reporting the results of sLND in patients with recurrent PCa limited to the nodes. Methods: 140 patients treated with sLND for nodal recurrence after RP documented by PET/CT scan between 2002 and 2016 were identified. Transfusions, length of stay (LoS), and 30-day complications were analyzed. Biochemical response (BR) was defined as PSA < 0.2ng/ml at 40-day. Clinical recurrence (CR) was defined as positive findings at postoperative imaging. Kaplan-Meier and Cox regression analyses were used. Results: Median age sLND was 66 years. Median PSA at sLND was 2.0ng/ml. Overall, 58.6, 14.4, and 15.0% patients had positive spots in the pelvic, retroperitoneal, and pelvic + retroperitoneal regions. Overall, 19.3, 2.9, and 77.8% patients received a LND in the pelvic, retroperitoneal, and pelvic + retroperitoneal regions. The median number of nodes removed was 27. Overall, 107 (76.4%) patients had positive nodes at sLND. Overall, 10 (7.1%) experienced grade 3-5 complications according to Clavien-Dindo and 12 (11.8%) patients received blood transfusions. Median LoS was 7 days. Median follow-up was 71 months. Overall, 54 (38.6%) patients achieved BR. The 8-year BCR free-survival rate in patients with BR was 44.7%. CR and CMS was observed in 50 and 25 patients. The 8-year CR and CSM-free-survival rates were 43.2 and 66.4%. In the preoperative model, retroperitoneal spots (Hazard ratio [HR]: 1.89; 95% confidence interval [CI]: 1.02-3.69) and the number of positive spots (HR: 1.26; 95%CI: 1.04-1.57) were predictors of CR. In the postoperative model, BR (HR: 0.33; 95%CI: 0.17-0.72), retroperitoneal involvement (HR: 3.48; 95%CI: 1.22-8.19), and the number of positive nodes (HR: 1.03; 95%CI: 1.01-1-06) were predictors of CR. Conclusions: sLND was associated with a low rate of high-grade complications. At 8-year, more than 40% of patients were free from CR. Retroperitoneal involvement and nodal burden were predictors of response. sLND might represent a therapeutic option for selected patients with nodal recurrence after RP.