Extended versus Standard Pelvic Lymph Node Dissection in Radical Prostatectomy on Oncological and Functional Outcomes: A Systematic Review and Meta-Analysis
We evaluated the effect of the extent of pelvic lymph node dissection (PLND) on oncological and functional outcomes in patients with intermediate- to high-risk prostate cancer (PCa) by conducting a systematic review and meta-analysis.
Two independent researchers performed a systematic review of radical prostatectomy (RP) with extended PLND (ePLND), and RP with standard (sPLND) or limited PLND (lPLND) in patients with PCa using the PubMed, EMBASE, and Cochrane Library databases and using the terms ‘prostatectomy’, ‘lymph node excision’, and ‘prostatic neoplasm’. The primary outcome was biochemical-free survival, which was analyzed by extracting survival data from the published Kaplan–Meier (KM) curves. In addition, we obtained summarized survival curves by reconstructing the KM data. Secondary outcomes of the recovery of erection and continence were also analyzed.
Nine studies involving over 1554 patients were included, one of which was a randomized controlled trial. The pooled analysis showed a significant difference in biochemical recurrence between ePLND and sPLND (hazard ratio 0.71, 95% confidence interval 0.56–0.90, p = 0.005), with no significant between-study heterogeneity (I 2 = 37%). From the summary survival curves, it can be observed that the curves for the two groups diverged more and more as a function of time. From the analyses of functional outcomes including only three studies, no statistically significant differences in the recovery of erectile function and continence were observed. No evidence of significant publication bias was found.
In patients with PCa, ePLND could be an oncological benefit; however, a functional compromise cannot be determined.
KeywordsRadical Prostatectomy Erectile Function Biochemical Recurrence Pelvic Lymph Node Dissection Pelvic Plexus
Min Soo Choo, Myong Kim, Ja Hyeon Ku, Cheol Kwak, Hyeon Hoe Kim, and Chang Wook Jeong declare that they have no conflicts of interest.
This research was supported by Grant No 23-2013-0050 from the Seoul National University Hospital (SNUH) Research Fund.
- 2.Gandaglia G, Di-Trapani E, Briganti A. Extended lymph node dissection in prostate cancer: a procedure with therapeutic utility. Oncology (Williston Park). 2014;28(7):600–602.Google Scholar
- 19.Deeks JJ, Higgins JPT, Altman DG. Analysing data and undertaking meta-analysis. In: Higgins J, Green S (eds). Cochrane Handbook for systematic review of interventions. London: The Cochrane Collaboration; 2008.Google Scholar
- 26.Sagalovich D, Calaway A, Srivastava A, Sooriakumaran P, Tewari AK. Assessment of required nodal yield in a high risk cohort undergoing extended pelvic lymphadenectomy in robotic-assisted radical prostatectomy and its impact on functional outcomes. BJU Int. 2013;111(1):85-94.CrossRefPubMedGoogle Scholar
- 27.Choo MS, Han JH, Lee SH, Kwak C, Kim HH. The impact of anatomic extent of pelvic lymph node dissection on sexual function recovery after nerve-sparing robot-assisted laparoscopic prostatectomy. J Endourol. 2014;28(S1):P1-A316.Google Scholar