Perioperative complications increase with the extent of pelvic lymph node dissection (PLND) during radical prostatectomy (RP), researchers confirm.
Giovanni E. Cacciamani, MD, of the University of Southern California in Los Angeles, California, and colleagues performed a systematic review of 176 studies involving 77,303 patients who underwent RP and published their results in European Urology Oncology. Among 28,428 patients in 84 studies that described intraoperative complications, 534 (1.8%) had 1 or more intraoperative complications, such as nerve injury. Among 73,629 patients in 151 studies that described postoperative complications, 10,401 (14.1%) had 1 or more postoperative complications, such as lymphocele or thromboembolic events.
According to a pooled meta-analysis, patients who had limited or standard PLND had a significant 45% and 54% decreased risk of intraoperative and postoperative complications strongly related to PLND, respectively, compared with patients who had extended or superextended PLND.
The most commonly reported postoperative complication was lymphocele (90.6%). The risk for lymphocele formation was a significant 48% lower with limited or standard PLND compared with extended or superextended PLND. A pooled meta-analysis showed that patients who had a higher number of lymph nodes retrieved had a significant 1.8-fold increased risk of lymphocele formation compared with those who had a lower number of lymph nodes retrieved, the investigators reported.
The risk for thromboembolic events was a significant 41% lower with limited or standard PLND.
Extended PLND includes nodes of the obturator and external and internal iliac, whereas superextended PLND also includes the common iliac, presacral, or other nodes.
“Given the high-rate of perioperative complications strongly and likely related to PLND, proper patient selection before the surgery and a tightened follow-up for patients according to PLND extension are of utmost importance,” Dr Cacciamani’s team stated.
The investigators added that more standardized reporting of intra- and postoperative complications is needed to better understand outcomes. They proposed a new PLND-related complication assessment tool incorporating European Association of Urology Ad Hoc Panel recommendations for that purpose. Dr Cacciamani’s team recommended that surgeons describe the sequelae of an intraoperative complication, timing, subsequent management (eg, medical or surgical intervention, intra- or postoperative management, etc), and postoperative course.
Complications related to RP and PLND should be defined as those strongly, likely, or unlikely related to PLND, and each event should be assigned a severity grade, according to the investigators.
Cacciamani GE, Maas M, Nassiri N, et al. Impact of pelvic lymph node dissection and its extent on perioperative morbidity in patients undergoing radical prostatectomy for prostate cancer: a comprehensive systematic review and meta-analysis. Eur Urol Oncol. Apr;4(2):134-149.doi:10.1016/j.euo.2021.02.001