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01-07-2017 | Urologic Oncology

Extended versus Standard Pelvic Lymph Node Dissection in Radical Prostatectomy on Oncological and Functional Outcomes: A Systematic Review and Meta-Analysis

Authors: Min Soo Choo, MD, Myong Kim, MD, Ja Hyeon Ku, MD, PhD, Cheol Kwak, MD, PhD, Hyeon Hoe Kim, MD, PhD, Chang Wook Jeong, MD, PhD

Published in: Annals of Surgical Oncology | Issue 7/2017

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

In patients with PCa, ePLND could be an oncological benefit; however, a functional compromise cannot be determined.

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Title: Extended versus Standard Pelvic Lymph Node Dissection in Radical Prostatectomy on Oncological and Functional Outcomes: A Systematic Review and Meta-Analysis
Authors: Min Soo Choo, MD
Myong Kim, MD
Ja Hyeon Ku, MD, PhD
Cheol Kwak, MD, PhD
Hyeon Hoe Kim, MD, PhD
Chang Wook Jeong, MD, PhD
Publication date: 01-07-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 7/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-5822-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Extended versus Standard Pelvic Lymph Node Dissection in Radical Prostatectomy on Oncological and Functional Outcomes: A Systematic Review and Meta-Analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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