Is Extended Pelvic Lymph Node Dissection Associated With Perioperative Complications?
Posted: Wednesday, February 10, 2021
According to Giovanni Cacciamani, MD, of the University of Southern California, Los Angeles, and colleagues, extended pelvic lymph node dissection seems to be associated with an increased risk of perioperative complications. The results of this systematic review and meta-analysis, which were presented during the virtual edition of the 2020 Society of Urologic Oncology (SUO) Annual Meeting (Abstract 193), may influence decisions regarding the extent of this procedure.
Using Medline, Web of Science, Scopus, and Embase, the investigators identified and analyzed 176 papers reporting nononcologic outcomes after radical prostatectomy and pelvic lymph node dissection. Intraoperative complications were described as an outcome of interest in 84 papers. Most papers (77.4%) reported at least one intraoperative complication; rectal injury was frequently described. According to the investigators, 11.6% of intraoperative complications seemed strongly related to pelvic lymph node dissection; this included obturator nerve and iliac vessel injury.
A total of 151 papers analyzed postoperative complications; 19 reported the complication rates after standard or extended pelvic lymph node dissection. Most papers (90.7%) reported at least one postoperative complication; lymphatic system morbidities occurred most frequently. Lymphocele was the most commonly reported complication that appeared to be strongly associated with pelvic lymph node dissection (90.6%).
Compared with extended/super-extended pelvic lymph node dissection, standard/limited pelvic lymph node dissection seemed to be associated with a significantly decreased risk of intraoperative complications (relative risk: 0.55; P = .01) and pelvic lymph node dissection–related postoperative complications (relative risk = 0.55; P = .01). According to the investigators, the extent of pelvic lymph node dissection appears to be an independent predictor of lymphocele formation (relative risk = 177; P > .0001).
Disclosure: No information regarding conflicts of interest was provided.
