The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review
There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa). To systematically review the relevant literature assessing the relative benefits and harms of PLND for oncological and non-oncological ou...
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| Published in | European urology Vol. 72; no. 1; pp. 84 - 109 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Switzerland
Elsevier B.V
01.07.2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0302-2838 1873-7560 1421-993X 1873-7560 |
| DOI | 10.1016/j.eururo.2016.12.003 |
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| Abstract | There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa).
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.
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.
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.
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.
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.
Although representing the most accurate staging procedure, pelvic lymph node dissection (PLND)—irrespective of the extent (limited/standard vs [super]extended PLND)—is 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. |
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| AbstractList | There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa).CONTEXTThere is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa).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.OBJECTIVETo 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.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 ACQUISITIONMEDLINE, 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.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.EVIDENCE SYNTHESISOverall, 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.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.CONCLUSIONSAlthough 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.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.PATIENT SUMMARYBased 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. There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa). 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. 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. 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. 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. 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. Although representing the most accurate staging procedure, pelvic lymph node dissection (PLND)—irrespective of the extent (limited/standard vs [super]extended PLND)—is 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. 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. There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa). 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. 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. 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. 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. 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. |
| Author | Fossati, Nicola Matveev, Vsevolod B. Henry, Ann M. Yuan, Cathy Yuhong MacPepple, Ekelechi Schoots, Ivo G. Mason, Malcolm D. Van den Broeck, Thomas van der Poel, Henk G. van den Bergh, Roderick C.N. Cornford, Philip Bellmunt, Joaquim De Santis, Maria Willemse, Peter-Paul M. Lam, Thomas B. Mottet, Nicolas Bolla, Michel Joniau, Steven van der Kwast, Theo H. Wiegel, Thomas Rouvière, Olivier Briers, Erik |
| Author_xml | – sequence: 1 givenname: Nicola surname: Fossati fullname: Fossati, Nicola organization: Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy – sequence: 2 givenname: Peter-Paul M. surname: Willemse fullname: Willemse, Peter-Paul M. organization: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands – sequence: 3 givenname: Thomas surname: Van den Broeck fullname: Van den Broeck, Thomas organization: Department of Urology, University Hospitals Leuven, and Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium – sequence: 4 givenname: Roderick C.N. surname: van den Bergh fullname: van den Bergh, Roderick C.N. organization: Department of Urology, University Medical Centre, Utrecht, The Netherlands – sequence: 5 givenname: Cathy Yuhong surname: Yuan fullname: Yuan, Cathy Yuhong organization: Division of Gastroenterology and Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada – sequence: 6 givenname: Erik surname: Briers fullname: Briers, Erik organization: Patient Advocate, Hasselt, Belgium – sequence: 7 givenname: Joaquim surname: Bellmunt fullname: Bellmunt, Joaquim organization: Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA – sequence: 8 givenname: Michel surname: Bolla fullname: Bolla, Michel organization: Department of Radiation Therapy, CHU Grenoble, Grenoble, France – sequence: 9 givenname: Philip surname: Cornford fullname: Cornford, Philip organization: Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK – sequence: 10 givenname: Maria surname: De Santis fullname: De Santis, Maria organization: University of Warwick, Cancer Research Centre, Coventry, UK – sequence: 11 givenname: Ekelechi surname: MacPepple fullname: MacPepple, Ekelechi organization: Surrey Health Economic Centre, School of Economics, University of Surrey, Guilford, UK – sequence: 12 givenname: Ann M. surname: Henry fullname: Henry, Ann M. organization: Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK – sequence: 13 givenname: Malcolm D. surname: Mason fullname: Mason, Malcolm D. organization: Cardiff University, Velindre Hospital, Cardiff, UK – sequence: 14 givenname: Vsevolod B. surname: Matveev fullname: Matveev, Vsevolod B. organization: N.N. Blokhin Cancer Research Center, Moscow, Russia – sequence: 15 givenname: Henk G. surname: van der Poel fullname: van der Poel, Henk G. organization: Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands – sequence: 16 givenname: Theo H. surname: van der Kwast fullname: van der Kwast, Theo H. organization: Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands – sequence: 17 givenname: Olivier surname: Rouvière fullname: Rouvière, Olivier organization: Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France – sequence: 18 givenname: Ivo G. surname: Schoots fullname: Schoots, Ivo G. organization: Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands – sequence: 19 givenname: Thomas surname: Wiegel fullname: Wiegel, Thomas organization: Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany – sequence: 20 givenname: Thomas B. surname: Lam fullname: Lam, Thomas B. organization: Academic Urology Unit, University of Aberdeen, Aberdeen, UK – sequence: 21 givenname: Nicolas surname: Mottet fullname: Mottet, Nicolas organization: Department of Urology, University Hospital, St. Etienne, France – sequence: 22 givenname: Steven surname: Joniau fullname: Joniau, Steven email: steven.joniau@uzleuven.be organization: Department of Urology, University Hospitals Leuven, and Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28126351$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adult Aged Aged, 80 and over Complications Disease-Free Survival Functional outcome Humans Lymph node dissection Lymph Node Excision - adverse effects Lymph Node Excision - methods Lymph Node Excision - mortality Lymph Nodes - pathology Lymph Nodes - surgery Lymphatic Metastasis Male Middle Aged Neoplasm Grading Neoplasm Staging Odds Ratio Oncological outcome Postoperative Complications - etiology Prostate cancer Prostatectomy - adverse effects Prostatectomy - methods Prostatectomy - mortality Prostatic Neoplasms - mortality Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Risk Assessment Risk Factors Staging Surgery Systematic review Time Factors Treatment Outcome Urology |
| Title | The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review |
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