title: Extended versus Standard Pelvic Lymph Node Dissection in Radical Prostatectomy on Oncological and Functional Outcomes: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  We evaluated the effect of the extent of pelvic lymph node dissection (PLND) on oncological and functional outcomes in patients with intermediate- to high-risk prostate cancer (PCa) by conducting a systematic review and meta-analysis.
  
  
  METHODS
  Two independent researchers performed a systematic review of radical prostatectomy (RP) with extended PLND (ePLND), and RP with standard (sPLND) or limited PLND (lPLND) in patients with PCa using the PubMed, EMBASE, and Cochrane Library databases and using the terms 'prostatectomy', 'lymph node excision', and 'prostatic neoplasm'. The primary outcome was biochemical-free survival, which was analyzed by extracting survival data from the published Kaplan-Meier (KM) curves. In addition, we obtained summarized survival curves by reconstructing the KM data. Secondary outcomes of the recovery of erection and continence were also analyzed.
  
  
  RESULTS
  Nine studies involving over 1554 patients were included, one of which was a randomized controlled trial. The pooled analysis showed a significant difference in biochemical recurrence between ePLND and sPLND (hazard ratio 0.71, 95% confidence interval 0.56-0.90, p = 0.005), with no significant between-study heterogeneity (I2= 37%). From the summary survival curves, it can be observed that the curves for the two groups diverged more and more as a function of time. From the analyses of functional outcomes including only three studies, no statistically significant differences in the recovery of erectile function and continence were observed. No evidence of significant publication bias was found.
  
  
  CONCLUSIONS
  In patients with PCa, ePLND could be an oncological benefit; however, a functional compromise cannot be determined.
authors.affiliation: Department of Urology, Dongtan Sacred Heart Hospital, Hwaseong, Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Choo
authors.affiliation: Department of Urology, Asan Medical Center, Seoul, Korea.
authors.forename: Myong
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea. drboss@gmail.com.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
mesh_terms: D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality*; D008198:Lymph Nodes / Q000601:surgery*; D008297:Male; D008495:Medical Oncology; D010388:Pelvis / Q000601:surgery*; D011379:Prognosis; D011468:Prostatectomy / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate