title: The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review.
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.
authors.affiliation: Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Peter-Paul M
authors.initials: PM
authors.lastname: Willemse
authors.affiliation: Department of Urology, University Hospitals Leuven, and Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Van den Broeck
authors.affiliation: Department of Urology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Roderick C N
authors.initials: RCN
authors.lastname: van den Bergh
authors.affiliation: Division of Gastroenterology and Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada.
authors.forename: Cathy Yuhong
authors.initials: CY
authors.lastname: Yuan
authors.affiliation: Patient Advocate, Hasselt, Belgium.
authors.forename: Erik
authors.initials: E
authors.lastname: Briers
authors.affiliation: Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.affiliation: Department of Radiation Therapy, CHU Grenoble, Grenoble, France.
authors.forename: Michel
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authors.lastname: Bolla
authors.affiliation: Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Cornford
authors.affiliation: University of Warwick, Cancer Research Centre, Coventry, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: De Santis
authors.affiliation: Surrey Health Economic Centre, School of Economics, University of Surrey, Guilford, UK.
authors.forename: Ekelechi
authors.initials: E
authors.lastname: MacPepple
authors.affiliation: Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Henry
authors.affiliation: Cardiff University, Velindre Hospital, Cardiff, UK.
authors.forename: Malcolm D
authors.initials: MD
authors.lastname: Mason
authors.affiliation: N.N. Blokhin Cancer Research Center, Moscow, Russia.
authors.forename: Vsevolod B
authors.initials: VB
authors.lastname: Matveev
authors.affiliation: Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Henk G
authors.initials: HG
authors.lastname: van der Poel
authors.affiliation: Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Theo H
authors.initials: TH
authors.lastname: van der Kwast
authors.affiliation: Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rouvière
authors.affiliation: Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Ivo G
authors.initials: IG
authors.lastname: Schoots
authors.affiliation: Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiegel
authors.affiliation: Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Lam
authors.affiliation: Department of Urology, University Hospital, St. Etienne, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mottet
authors.affiliation: Department of Urology, University Hospitals Leuven, and Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium. Electronic address: steven.joniau@uzleuven.be.
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; Functional outcome; Lymph node dissection; Oncological outcome; Prostate cancer; Staging; Surgery; Systematic review