1
|
Ding G, Tang G, Wang T, Zou Q, Cui Y, Wu J. A comparative analysis of perioperative complications and biochemical recurrence between standard and extended pelvic lymph node dissection in prostate cancer patients undergoing radical prostatectomy: a systematic review and meta-analysis. Int J Surg 2024; 110:1735-1743. [PMID: 38052016 PMCID: PMC10942186 DOI: 10.1097/js9.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Pelvic lymph node dissection (PLND) is commonly performed during radical prostatectomy (RP) for prostate cancer staging. This study aimed to comprehensively analyze existing evidence compare perioperative complications associated with standard (sPLND) versus extended PLND templates (ePLND) in RP patients. METHODS A meta-analysis of prospective studies on PLND complications was conducted. Systematic searches were performed on Web of Science, Pubmed, Embase, and the Cochrane Library until May 2023. Risk ratios (RRs) were estimated using random-effects models in the meta-analysis. The statistical analysis of the data was carried out using Review Manager software. RESULTS Nine studies, including three randomized clinical trial and six prospective studies, with a total of 4962 patients were analyzed. The meta-analysis revealed that patients undergoing ePLND had a higher risk of partial perioperative complications, such as lymphedema ( I2 =28%; RR 0.05; 95% CI: 0.01-0.27; P <0.001) and urinary retention ( I2 =0%; RR 0.30; 95% CI: 0.09-0.94; P =0.04) compared to those undergoing sPLND. However, there were no significant difference was observed in pelvic hematoma ( I2 =0%; RR 1.65; 95% CI: 0.44-6.17; P =0.46), thromboembolic ( I2 =57%; RR 0.91; 95% CI: 0.35-2.38; P =0.85), ureteral injury ( I2 =33%; RR 0.28; 95% CI: 0.05-1.52; P =0.14), intraoperative bowel injury ( I2 =0%; RR 0.87; 95% CI: 0.14-5.27; P =0.88), and lymphocele ( I2 =0%; RR 1.58; 95% CI: 0.54-4.60; P =0.40) between sPLND and ePLND. Additionally, no significant difference was observed in overall perioperative complications ( I2 =85%; RR 0.68; 95% CI: 0.40-1.16; P =0.16). Furthermore, ePLND did not significantly reduce biochemical recurrence ( I2 =68%; RR 0.59; 95% CI: 0.28-1.24; P =0.16) of prostate cancer. CONCLUSION This analysis found no significant differences in overall perioperative complications or biochemical recurrence between sPLND and ePLND, but ePLND may offer enhanced diagnostic advantages by increasing the detection rate of lymph node metastasis.
Collapse
Affiliation(s)
| | | | | | | | - Yuanshan Cui
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, People’s Republic of China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, People’s Republic of China
| |
Collapse
|
2
|
Zheng Y, Gao Y, Cheng Y, Qi F, Zou Q. Whether extended pelvic lymph node dissection should be performed in prostate cancer: The present evidence from a systematic review and meta‐analysis. PRECISION MEDICAL SCIENCES 2020. [DOI: 10.1002/prm2.12005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yuxiao Zheng
- Department of Urologic SurgeryJiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital Nanjing 210009 China
| | - Yang Gao
- Department of RadiologyJiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital Nanjing 210009 China
| | - Yifei Cheng
- Department of UrologyThe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Feng Qi
- Department of Urologic SurgeryJiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital Nanjing 210009 China
| | - Qing Zou
- Department of Urologic SurgeryJiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital Nanjing 210009 China
| |
Collapse
|
3
|
Tyritzis SI, Kalampokis N, Grivas N, van der Poel H, Wiklund NP. Robot-assisted extended lymphadenectomy in prostate cancer. MINERVA CHIR 2018; 74:88-96. [PMID: 30037178 DOI: 10.23736/s0026-4733.18.07780-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The extent of lymph node dissection (LND) and its potential survival benefit are still a matter of debate. Aim of our review was to summarize the latest literature data regarding the surgical templates, the potential oncological benefits, the functional outcomes and the complications of extended lymph node dissection (eLND) during robot-assisted radical prostatectomy (RARP). EVIDENCE ACQUISITION We systematically reviewed all relevant studies using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) guidelines. EVIDENCE SYNTHESIS A narrative synthesis of all relevant publications on surgical templates, complications, oncological and functional outcomes of robot assisted eLND was undertaken. CONCLUSIONS A great deal of evidence supports that an extended template of LND is not only technically feasible but also safe in the context of RARP. It is really promising that in the era of minimally invasive surgery, parameters like the lymph node yield and the detection rates of positive lymph nodes during LND have become highly comparable with open series. The extended approach has already proved its benefits in terms of proper patient staging but more studies are needed with regard to functional outcomes and oncological benefits of this procedure.
Collapse
Affiliation(s)
- Stavros I Tyritzis
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden - .,Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece -
| | | | - Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece.,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital Amsterdam, Amsterdam, The Netherlands
| | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital Amsterdam, Amsterdam, The Netherlands
| | - N Peter Wiklund
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
4
|
Matulay JT, DeCastro GJ. Radical Prostatectomy for High-risk Localized or Node-Positive Prostate Cancer: Removing the Primary. Curr Urol Rep 2018; 18:53. [PMID: 28589400 DOI: 10.1007/s11934-017-0703-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW We reviewed the literature to determine what role, if any, radical prostatectomy should play in the treatment of high-risk and/or node-positive prostate cancer. RECENT FINDINGS The AUA, NCCN, and EAU all include radical prostatectomy as a treatment option for high-risk prostate cancer based on evidence that has shown improvements in biochemical-free and disease-specific survival. Lymph node-positive patients may also derive benefit from radical prostatectomy with lymph node dissection, however, only retrospective studies with high risk of selection bias have been published to date. High-risk prostate cancer is a heterogeneous disease representing a wide range of disease characteristics. Radical surgery, historically avoided in such patients, may now be considered a valid treatment option for select cases. The adverse effects of surgery using modern techniques lead to similar quality of life outcomes as radiation therapy, and treatment of the primary tumor is likely beneficial when compared to ADT alone.
Collapse
Affiliation(s)
- Justin T Matulay
- Department of Urology, Columbia University Medical Center, 161 Fort Washington Ave, 11th Floor, New York, NY, 10032, USA
| | - G Joel DeCastro
- Department of Urology, Columbia University Medical Center, 161 Fort Washington Ave, 11th Floor, New York, NY, 10032, USA.
| |
Collapse
|
5
|
Siriwardana A, Thompson J, van Leeuwen PJ, Doig S, Kalsbeek A, Emmett L, Delprado W, Wong D, Samaratunga H, Haynes AM, Coughlin G, Stricker P. Initial multicentre experience of 68
gallium-PSMA PET/CT guided robot-assisted salvage lymphadenectomy: acceptable safety profile but oncological benefit appears limited. BJU Int 2017; 120:673-681. [DOI: 10.1111/bju.13919] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Amila Siriwardana
- St Vincent's Prostate Cancer Centre; St Vincent's Clinic; Sydney NSW Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| | - James Thompson
- St Vincent's Prostate Cancer Centre; St Vincent's Clinic; Sydney NSW Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| | - Pim J. van Leeuwen
- Department of Urology; Erasmus University Medical Centre; Rotterdam The Netherlands
| | | | - Anton Kalsbeek
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| | - Louise Emmett
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
| | | | | | - Hemamali Samaratunga
- School of Medicine; University of Queensland; Brisbane QLD Australia
- Aquesta Pathology; Brisbane QLD Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| | | | - Phillip Stricker
- St Vincent's Prostate Cancer Centre; St Vincent's Clinic; Sydney NSW Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Sydney NSW Australia
- School of Medicine; University of New South Wales; Sydney NSW Australia
- Australian Prostate Cancer Research Centre; Sydney NSW Australia
| |
Collapse
|
6
|
Li B, Li C. Suppression of Prostate Cancer Metastasis by DPYSL3-Targeted saRNA. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017. [DOI: 10.1007/978-981-10-4310-9_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
7
|
Gnanapragasam VJ, Hori S, Johnston T, Smith D, Muir K, Alonzi R, Winkler M, Warren A, Staffurth J, Khoo V, Tree A, Macneill A, McMenemin R, Mason M, Cathcart P, de Souza N, Sooriakumaran P, Weston R, Wylie J, Hall E, Lane A, Cross W, Syndikus I, Koupparis A. Clinical management and research priorities for high-risk prostate cancer in the UK: Meeting report of a multidisciplinary panel in conjunction with the NCRI Prostate Cancer Clinical Studies Localised Subgroup. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816651362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of high-risk prostate cancer has become increasingly sophisticated, with refinements in radical therapy and the inclusion of adjuvant local and systemic therapies. Despite this, high-risk prostate cancer continues to have significant treatment failure rates, with progression to metastasis, castrate resistance and ultimately disease-specific death. In an effort to discuss the challenges in this field, the UK National Clinical Research Institute’s Prostate Cancer Clinical Studies localised subgroup convened a multidisciplinary national meeting in the autumn of 2014. The remit of the meeting was to debate and reach a consensus on the key clinical and research challenges in high-risk prostate cancer and to identify themes that the UK would be best placed to pursue to help improve outcomes. This report presents the outcome of those discussions and the key recommendations for future research in this highly heterogeneous disease entity.
Collapse
Affiliation(s)
| | - S Hori
- Academic Urology Group, University of Cambridge, UK
| | - T Johnston
- Academic Urology Group, University of Cambridge, UK
| | - D Smith
- Prostate Cancer Support Association, UK
| | - K Muir
- Institute of Public Health, University of Manchester, UK
| | - R Alonzi
- Department of Clinical Oncology, Mount Vernon Cancer Centre, UK
| | - M Winkler
- Department of Urology, Charing Cross Hospital, UK
| | - A Warren
- Department of Pathology, Addenbrookes Hospital, UK
| | - J Staffurth
- Institute of Cancer and Genetics, Cardiff University, UK
| | - V Khoo
- Department of Clinical Oncology, Royal Marsden Hospital, UK
| | - A Tree
- Department of Clinical Oncology, Royal Marsden Hospital, UK
| | - A Macneill
- Department of Urology, Western General Hospital, NHS Lothian, UK
| | | | - M Mason
- Institute of Cancer and Genetics, Cardiff University, UK
| | - P Cathcart
- Department of Urology, UCL Hospitals, UK
| | | | | | - R Weston
- Department of Urology, Royal Liverpool University Hospital, UK
| | - J Wylie
- Department of Oncology, Christie Hospital, UK
| | - E Hall
- Clinical Trials and Statistics Unit; Institute of Cancer Research, UK
| | - A Lane
- Department of Social Medicine, University of Bristol, UK
| | - W Cross
- Department of Urology, St. James’s University Hospital, UK
| | - I Syndikus
- Radiotherapy Department, Clatterbridge Cancer Centre, UK
| | - A Koupparis
- Department of Urology, Bristol Urological Institute, UK
| | | |
Collapse
|
8
|
Therapeutic role of systematic lymphadenectomy in early-stage endometrial cancer: A systematic review. Oncol Lett 2016; 11:3849-3857. [PMID: 27313706 DOI: 10.3892/ol.2016.4467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/18/2016] [Indexed: 12/29/2022] Open
Abstract
The purpose of the current review was to examine whether systematic lymphadenectomy is safe and effective for treating early-stage endometrial cancer. PubMed, Embase, the Cochrane Library and the China National Knowledge Infrastructure databases were systematically searched during April 2014 to identify studies comparing the use of systematic lymphadenectomy and no systematic lymphadenectomy in parallel for the treatment of early-stage endometrial cancer. A total of 13 eligible studies involving 51,155 patients were included in this review. The median overall survival (OS) rate at 5 years following lymphadenectomy was 90% (range, 73.1-98.3%) for patients undergoing the systematic procedure and 88.2% (range, 68-98.4%) for patients not undergoing the systematic procedure. For the two types of lymphadenectomy, OS has tended to improve over the last 20 years. The combined rate of disease-free and progression-free survival was higher in patients who underwent systematic lymphadenectomy, and the recurrence rate was lower. In particular, systematic lymphadenectomy was associated with markedly higher OS than the non-systematic procedure for patients with intermediate- and high-risk endometrial cancer when ≥11 lymph nodes were removed. Systematic lymphadenectomy demonstrates clinical benefit in patients with early-stage endometrial cancer and should thus be a standard treatment option. In conclusion, systematic lymphadenectomy leads to higher OS than no systematic lymphadenectomy in intermediate- and high-risk patients with early-stage endometrial cancer, particularly when the procedure removes ≥11 lymph nodes.
Collapse
|
9
|
Harbin AC, Eun DD. The role of extended pelvic lymphadenectomy with radical prostatectomy for high-risk prostate cancer. Urol Oncol 2014; 33:208-16. [PMID: 25547974 DOI: 10.1016/j.urolonc.2014.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/22/2014] [Accepted: 11/20/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION 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. CONCLUSION 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.
Collapse
Affiliation(s)
- Andrew C Harbin
- Department of Urology, Temple University Hospital, Philadelphia, PA.
| | - Daniel D Eun
- Department of Urology, Temple University Hospital, Philadelphia, PA
| |
Collapse
|