Introduction:
Pelvic lymph node dissection (PLND) plays a critical role in the staging and management of clinically localized prostate cancer, but there is debate as to the optimal extent of lymph node dissection. Although there is limited research in the oncologic benefit of extended PLND, the European Association of Urology (EAU) currently still recommends an extended approach for high-risk patients. The goal of this study was to evaluate the difference in complication rates following standard vs. extended lymph node dissection.
Methods:
We conducted a systematic review and metanalysis in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Metanalysis) guidelines. Medline, Web of Science, Scopus, and Embase were queried for papers reporting non-oncologic outcomes following radical prostatectomy and PLND. Inclusion criteria was surgical series n >10, intraoperative or postoperative complications as an outcome of interest, and English language. Standard vs. extended PLND was defined according to the EAU guidelines. Patient demographics, quality of complication reporting, intraoperative, and postoperative complications were recorded for each paper.
Results:
Our search produced 3,645 papers and 1,454 remained after removing duplicates. A total of 176 studies met inclusion criteria. 84 papers described intraoperative complications as an outcome of interest. 65 (77.4%) reported at least one intraoperative complication, with rectal injury being the most common. The rate of intraoperative complications strongly related to PLND was 11.6% and included obturator nerve and iliac vessel injury. 151 papers analyzed postoperative complications and 19 specially reported the complication rates following standard vs. extended PLND. 137 papers (90.7%) reported at least one postoperative complication, with lymphatic system morbidities most common. Lymphocele was the most frequently reported complication (90.6%) strongly related to PLND. Our metanalysis revealed a statistically significant decreased risk of intraoperative complications (RR:0.55; p=0.01) and PLND-related postoperative complications (RR:0.55; p=0.01) with standard/limited PLND compared to extended/super-extended. Extent of PLND is an independent predictor of lymphocele formation (RR:177, p>0.0001).
Conclusion:
While extended PLND may confer an oncologic benefit, it is associated with an increased risk of intraoperative and postoperative complications, especially lymphocele formation. Shared decision making must be undertaken between patient and practitioner when deciding extent of PLND.
Funding: N/A
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Impact of Pelvic Lymph Node Dissection and its Extension on Perioperative Complications and Morbidity in Patients with Prostate Cancer
Category
Prostate Cancer > Potentially Localized
Description
Poster #193
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Presented By: Marissa Maas
Authors:
Marissa Maas
Nima Nassiri
George N Thalmann
Axel Heidenreich
James Eastham
Christopher Evans
Jeffrey Karnes
Andre Abreu
Alberto Briganti
Walter Artibani
Inderbir Gill
Francesco Montorsi
Giovanni Cacciamani