标准和扩大盆腔淋巴结清扫术在根治性前列腺切除术治疗前列腺癌患者中的围手术期并发症和生化复发的比较分析：系统评价和荟萃分析。

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.

机构信息

Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, People's Republic of China.

出版信息

Int J Surg. 2024 Mar 1;110(3):1735-1743. doi: 10.1097/JS9.0000000000000997.

DOI:10.1097/JS9.0000000000000997

PMID:38052016

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10942186/

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.

摘要

简介

在根治性前列腺切除术（RP）中，盆腔淋巴结清扫术（PLND）常用于前列腺癌分期。本研究旨在全面分析现有证据，比较标准（sPLND）与扩展 PLND 模板（ePLND）在 RP 患者中的围手术期并发症。

方法

对 PLND 并发症的前瞻性研究进行荟萃分析。在 Web of Science、Pubmed、Embase 和 Cochrane Library 上进行系统检索，检索时间截至 2023 年 5 月。使用随机效应模型在荟萃分析中估计风险比（RR）。使用 Review Manager 软件对数据进行统计学分析。

结果

共分析了 9 项研究，包括 3 项随机临床试验和 6 项前瞻性研究，共纳入 4962 例患者。荟萃分析显示，与 sPLND 相比，ePLND 患者发生部分围手术期并发症（如淋巴水肿[I2=28%；RR 0.05；95%CI：0.01-0.27；P<0.001]和尿潴留[I2=0%；RR 0.30；95%CI：0.09-0.94；P=0.04]）的风险更高。然而，在盆腔血肿（I2=0%；RR 1.65；95%CI：0.44-6.17；P=0.46）、血栓栓塞（I2=57%；RR 0.91；95%CI：0.35-2.38；P=0.85）、输尿管损伤（I2=33%；RR 0.28；95%CI：0.05-1.52；P=0.14）、术中肠损伤（I2=0%；RR 0.87；95%CI：0.14-5.27；P=0.88）和淋巴囊肿（I2=0%；RR 1.58；95%CI：0.54-4.60；P=0.40）方面，sPLND 和 ePLND 之间没有显著差异。此外，sPLND 和 ePLND 之间的总体围手术期并发症（I2=85%；RR 0.68；95%CI：0.40-1.16；P=0.16）也没有显著差异。此外，ePLND 并不能显著降低前列腺癌的生化复发率（I2=68%；RR 0.59；95%CI：0.28-1.24；P=0.16）。