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Review
. 2022 Apr 15;10(2):73-81.
eCollection 2022.

Comparison of perioperative complications for extended vs standard pelvic lymph node dissection in patients undergoing radical prostatectomy for prostate cancer: a meta-analysis

Jerry Kong  1 , Benjamin Lichtbroun  1   2 , Joshua Sterling  3 , Yaqun Wang  4 , Qingyang Wang  5 , Eric A Singer  1   2 , Thomas L Jang  1   2 , Saum Ghodoussipour  1   2 , Isaac Yi Kim  6
Affiliations
Review

Comparison of perioperative complications for extended vs standard pelvic lymph node dissection in patients undergoing radical prostatectomy for prostate cancer: a meta-analysis

Jerry Kong et al. Am J Clin Exp Urol. .

Abstract

Introduction: Pelvic lymph node dissection (PLND) is widely performed for staging in men undergoing radical prostatectomy (RP) for prostate cancer. Our goal was to synthesize all available evidence and data to evaluate perioperative complications for two templates of PLND, standard (sPLND) vs extended (ePLND), at the time of RP in patients with prostate cancer.

Methods: A meta-analysis was performed on relevant literature about complications during PLND. Pubmed, Scopus, WebofScience, and Cochrane Library were systematically searched through July 2021. Meta-analysis was conducted with both fixed-effects and random-effects models to estimate risk ratios (RRs) between treatments. A subgroup analysis was also conducted based on surgery type - open vs robotic.

Results: 13 (1 randomized clinical trial and 12 observational studies) studies published between 1997 and 2019 with a total of 7,036 patients were analyzed. Pooled data showed complications in a random-effects model was lower in the sPLND group than the ePLND group (RR, 0.62; 95% CI 0.40-0.97). In a subgroup analysis, neither the open surgery subgroup nor the robotic surgery subgroup showed significant differences in complication rate between sPLND and ePLND.

Conclusion: ePLND is associated with a significantly greater risk of perioperative complication compared to sPLND, but not when comparing these templates performed via a robotic approach. Additional studies comparing the complication rates of sPLND and ePLND when utilizing a robotic approach should be conducted.

Keywords: Prostate cancer; complications; extended pelvic lymph node dissection; pelvic lymph node dissection; pelvic lymphadenectomy; radical prostatectomy.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flow diagram of the identification of relevant studies for final meta-analysis. Abbreviations: LND, Lymph node dissection.
Figure 2
Figure 2
Forest plot showing perioperative complication in sPLND vs ePLND in a meta-analysis of 13 studies. Significant between study heterogeneity was detected (I-squared =77%, P≤0.01). Abbreviations: RR, Risk ratio.
Figure 3
Figure 3
Funnel plot for assessing publication bias. The test for asymmetry yielded a p-value of 0.188.
Figure 4
Figure 4
Forest plot showing perioperative complications in PLND vs ePLND in subgroup analysis by surgical method. No heterogeneity was detected in the Robotic subgroup (I-squared =0%, P=0.76). Significant between study heterogeneity was detected in the Open subgroup (I-squared =0%, P<0.01). Abbreviations: RR, Risk ratio.
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