1. Extended versus non-extended lymphadenectomy during radical cystectomy for patients with bladder cancer: a meta-analysis of the effect on long-term and short-term outcomes.
- Author
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Wang YC, Wu J, Dai B, Shen YJ, Ma CG, Ye DW, and Zhu YP
- Subjects
- Cystectomy methods, Humans, Lymph Node Excision methods, Lymph Nodes surgery, Lymphatic Metastasis, Pelvis pathology, Postoperative Complications etiology, Prognosis, Randomized Controlled Trials as Topic, Survival Rate, Treatment Outcome, Urinary Bladder Neoplasms pathology, Cystectomy mortality, Lymph Node Excision mortality, Urinary Bladder Neoplasms mortality, Urinary Bladder Neoplasms surgery
- Abstract
Background: Pelvic lymphadenectomy (PLND) is an integral part of curative surgery for high-risk non-muscle invasive and muscle-invasive bladder cancer. The therapeutic value of extended PLND is controversial., Methods: We conducted a comprehensive online search in PubMed, EMBASE, and the Cochrane Library databases for relevant literature directly comparing extended PLND (e-PLND) with non-extended PLND (ne-PLND) from database inception to June 2019. We performed the meta-analysis to evaluate the impact of PLND templates on recurrence-free survival (RFS), disease-specific survival (DSS), overall survival (OS), rates of postoperative major complications, and mortality within 90 days of surgery., Results: A total of 10 studies involving 3979 patients undergoing either e-PLND or ne-PLND were included. The results showed that e-PLND was significantly associated with better RFS (HR 0.74, 95% CI 0.62-0.90, p = 0.002) and DSS (HR 0.66, 95% CI 0.55-0.79, p < 0.001). However, no correlation was found between e-PLND template and a better OS (HR 0.93, 95% CI 0.55-1.58, p = 0.79). Postoperative major complications were similar between e-PLND group and ne-PLND group, as was mortality within 90 days of surgery., Conclusion: e-PLND template is correlated with favorable RFS and DSS outcomes for patients with bladder cancer. e-PLND did not have more postoperative major complications than did ne-PLND.
- Published
- 2019
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