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A systematic review and meta-analysis of comparative studies on the efficacy of extended pelvic lymph node dissection in patients with clinically localized prostatic carcinoma

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Abstract

Purpose

Pelvic lymph node dissection (PLND) has been performed during radical prostatectomy in nearly all patients with clinically localized prostatic carcinoma (PCa), while the specific regions that needed to be removed demonstrated bifurcation among urologist. However, clinical studies comparing extended PLND (ePLND) with standard PLND (sPLND) and limited PLND (lPLND) reveal conflicting, or even opposing results.

Methods

All controlled trials comparing ePLND with sPLND or lPLND were identified through comprehensive searches of the PubMed, Cochrane Library and Embase databases. A systematic review and meta-analysis of these studies were then performed.

Results

Eighteen studies with a total of 8,914 patients were included. Regardless of being compared with sPLND or lPLND, ePLND significantly improved LN retrieval [ePLND vs. sPLND: weighted mean difference (WMD) 11.93, 95 % confidence interval (CI) 9.91–13.95, p < 0.00001; ePLND vs. lPLND: WMD 8.27, 95 % CI 3.53–13.01, p = 0.0006] and the detection of more LNs positive of metastasis [risk ratio (RR) 3.51, 95 % CI 2.14–5.75, p < 0.00001; RR 3.50, 95 % CI 2.20–5.55, p < 0.00001, respectively]. EPLND decreased the complication rate, but the differences were not statistically significant (RR 1.52, 95 % CI 0.87–2.65, p = 0.14; RR 1.52, 95 % CI 0.67–3.45, p = 0.32, respectively). Operating time, estimated blood loss, length of hospital stay and biochemical recurrence (BCR) were statistically insignificant between techniques.

Conclusions

ePLND shows benefits associated with increased LNs yield, LNs positivity, and safety, significantly with no risk of side effects. However, ePLND did not decrease BCR. Additional high-quality, well-designed randomized controlled trials and comparative studies with long-term follow-up results are required to define the optimal procedure for patients with clinically localized PCa.

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Acknowledgments

We are greatly indebted to Professor Eden for his help in data supply. We also gratefully acknowledge Dr. Ling from Cardiac Surgery and Dr. Cai from General Surgery of West China Hospital for their help in the translation of Japanese. This paper was supported by the Pillar Program from Science and Technology Department of Sichuan Province (Grant No. 2012SZ0009).

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Authors and Affiliations

  1. Department of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China

    Liang Gao, Lu Yang, Xiao Lv, Siyuan Bu, Fan Wan, Shengqiang Qian, Qiang Wei, Ping Han & Tianyong Fan

  2. Department of Urology, People’s Hospital of Deyang City, Deyang, 618000, China

    Tianyong Fan

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  1. Liang Gao
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Correspondence to Tianyong Fan.

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Liang Gao and Lu Yang have contributed equally to this work and share the co-first author.

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Gao, L., Yang, L., Lv, X. et al. A systematic review and meta-analysis of comparative studies on the efficacy of extended pelvic lymph node dissection in patients with clinically localized prostatic carcinoma. J Cancer Res Clin Oncol 140, 243–256 (2014). https://doi.org/10.1007/s00432-013-1574-2

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