title: The role of extended pelvic lymphadenectomy with radical prostatectomy for high-risk prostate cancer.
abstract: BACKGROUND
  The role of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) for prostate cancer (PCa) is controversial. Despite extensive research in both patterns of lymphatic drainage and the clinical effect of lymph node involvement, the exact role of PLND in PCa is yet to be defined.
  
  
  METHODS
  A systematic search of the MEDLINE database was performed, and all relevant articles were reviewed in depth.
  
  
  RESULTS
  We included 84 relevant articles in our review and subdivided the information into the following categories: preoperative patient evaluation, procedure/extent of dissection, complications, and robotic surgery era. Most authors agree that the greatest benefit is seen in patients with high-risk PCa undergoing RP. Multiple imaging modalities have been evaluated for assistance in patient selection, but the use of preoperative nomograms appears to be the most helpful selection tool. The role of limited PLND vs. extended PLND (e-PLND) is yet to be defined, though many authors agree that e-PLND is preferred in the setting of high-risk PCa. Although PLND is associated with a higher incidence of complications, especially lymphocele formation, it is unclear whether e-PLND leads to more complications than limited PLND. The introduction of minimally invasive surgery may have had a negative effect on implementation of PLND in the appropriate patients undergoing RP.
  
  
  CONCLUSIONS
  Despite a lack of prospective, randomized trials evaluating PLND in RP, there does appear to be a consistent benefit in patients with high-risk disease.
authors.affiliation: Department of Urology, Temple University Hospital, Philadelphia, PA. Electronic address: aharbin@gmail.com.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Harbin
authors.affiliation: Department of Urology, Temple University Hospital, Philadelphia, PA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Eun
mesh_terms: D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D010388:Pelvis / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Extended pelvic lymph node dissection; High-risk prostate cancer; Radical prostatectomy