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The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review

Fossati, Nicola, Willemse, Peter-Paul M., Van den Broeck, Thomas, van den Bergh, Roderick C. N., Yuan, Cathy Yuhong, Briers, Erik, Bellmunt, Joaquim, Bolla, Michel, Cornford, Philip, De Santis, Maria, MacPepple, Ekelechi, Henry, Ann M., Mason, Malcolm D., Matveev, Vsevolod B., van der Poel, Henk G., van der Kwast, Theo H., Rouviere, Olivier, Schoots, Ivo G., Wiegel, Thomas, Lam, Thomas B., Mottet, Nicolas and Joniau, Steven 2017. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. European Urology 72 (1) , pp. 84-109. 10.1016/j.eururo.2016.12.003

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Abstract

Context There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa). Objective To systematically review the relevant literature assessing the relative benefits and harms of PLND for oncological and non-oncological outcomes in patients undergoing radical prostatectomy for PCa. Evidence acquisition MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched up to December 2015. Comparative studies evaluating no PLND, limited, standard, and (super)-extended PLND that reported oncological and non-oncological outcomes were included. Risk-of-bias and confounding assessments were performed. A narrative synthesis was undertaken. Evidence synthesis Overall, 66 studies recruiting a total of 275,269 patients were included (44 full-text articles and 22 conference abstracts). Oncological outcomes were addressed by 29 studies, one of which was a randomized clinical trial (RCT). Non-oncological outcomes were addressed by 43 studies, three of which were RCTs. There were high risks of bias and confounding in most studies. Conflicting results emerged when comparing biochemical and clinical recurrence, while no significant differences were observed among groups for survival. Conversely, the majority of studies showed that the more extensive the PLND, the greater the adverse outcomes in terms of operating time, blood loss, length of stay, and postoperative complications. No significant differences were observed in terms of urinary continence and erectile function recovery. Conclusions Although representing the most accurate staging procedure, PLND and its extension are associated with worse intraoperative and perioperative outcomes, whereas a direct therapeutic effect is still not evident from the current literature. The current poor quality of evidence indicates the need for robust and adequately powered clinical trials. Patient summary Based on a comprehensive review of the literature, this article summarizes the benefits and harms of removing lymph nodes during surgery to remove the prostate because of PCa. Although the quality of the data from the studies was poor, the review suggests that lymph node removal may not have any direct benefit on cancer outcomes and may instead result in more complications. Nevertheless, the procedure remains justified because it enables accurate assessment of cancer spread.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: Elsevier
ISSN: 0302-2838
Date of First Compliant Deposit: 16 January 2018
Date of Acceptance: 1 December 2016
Last Modified: 28 Jan 2018 14:42
URI: http://orca-mwe.cf.ac.uk/id/eprint/102656

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