Whether extended pelvic lymph node dissection should be performed in prostate cancer: The present evidence from a systematic review and meta‐analysis

Abstract Purpose To compare non‐extended pelvic lymph node dissection (nePLND) with extended pelvic lymph node dissection (ePLND) in outcomes and complications of patients with prostate cancer (PCa). Methods A comprehensive search of the PubMed, EMBASE, and Web of Science was performed. We extracted the first author, year of publication, basic characteristics of patients, method of radical prostatectomy (RP), extent of PLND, number of lymph node yields (LNY), and percentage of LN metastasis. Besides, information about inpatients outcomes and complications were also collected. The modified Newcastle‐Ottawa scale was compiled to assess the level of evidence of all controlled studies. Next, we used odds ratio (OR) with corresponding 95% confidence interval (CI) to evaluate the difference between nePLND and ePLND in meta‐analysis, and a P value of <.05 was considered statistically significant. Results A total of 11 studies including 7489 patients were included in our study. Compared with nePLND, more LNY and metastasized LNs (OR = 3.104, 95% CI: 2.407‐4.001, z = 8.74, P < .001) could be dissected by ePLND. Besides, more complications from ePLND group compared with nePLND group (ePLND vs nePLND: OR = 2.118, 95% CI: 1.107‐4.051, z = 2.27, P = .023). Furthermore, the results of subgroup analysis revealed that ePLND group led to more complications from all three RP approaches. In addition, our results showed that extender PLND led to more blood loss and longer operating room time in PCa patients with open radical prostatectomy (ORP). No statistics discrepancy in postoperative length of stay and operating room time was observed except one single study. Finally, there were no significant difference observed in transfusion and prostate weight. Conclusions The results of our study indicated that extender PLND led to more LNY and more metastasized LNs. More harm would be brought by ePLND in ORP, whereas not in LRP and RALP. In addition, ePLND may lead to more overall compilations than nePLND.