Which lymph node dissection template is optimal for radical cystectomy? A systematic review and Bayesian network
Wenqiang Qi1, Minglei Zhong1, Ning Jiang2
1Department of Urology, Qilu Hospital of Shandong University, Jinan, China.
Frontiers in Oncology
|December 12, 2022
Summary
Extended pelvic lymph node dissection (ePLND) offers improved recurrence-free survival for radical cystectomy patients. Super-extended PLND (sePLND) shows similar recurrence-free survival but offers no additional benefits over ePLND.
Area of Science:
- Urology
- Surgical Oncology
- Oncology
Background:
- Radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer.
- Pelvic lymph node dissection (PLND) is a critical component of RC, but optimal template remains debated.
- Different PLND templates (limited, standard, extended, super-extended) impact oncological outcomes and complications.
Approach:
- A systematic review and Bayesian network meta-analysis was performed.
- Included 18 studies comparing recurrence-free survival (RFS), disease-specific survival (DSS), overall survival (OS), and complications across four PLND templates.
- Data from December 2021 was analyzed to determine the optimal PLND strategy.
Key Points:
- Extended PLND (ePLND) and super-extended PLND (sePLND) were associated with significantly better RFS compared to standard (sPLND) and limited (lPLND) templates.
- No significant differences in DSS were observed among the four PLND templates.
- ePLND and sePLND showed improved OS compared to lPLND, with ePLND ranking highest for RFS and sePLND for OS.
- Postoperative complication rates did not significantly differ between any PLND templates.
Conclusions:
- ePLND appears to be the optimal PLND template for radical cystectomy, balancing improved RFS with manageable complexity.
- sePLND offers similar RFS to ePLND but involves greater operative challenges without clear prognostic advantages.
- Further research may refine PLND strategies to optimize outcomes in bladder cancer treatment.
