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Published on: February 12, 2022
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Pelvic Lymph Node Dissection Before Versus After Radical Cystectomy: A Systematic Review and Meta-Analysis
Guilherme Melchior Maia Lopes1, Luiz Guilherme Serrão Gimenez2, Diogo Souto Santana2
1Centro Universitário Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brasil.
Summary
Performing pelvic lymph node dissection (PLND) before radical cystectomy (RC) did not significantly impact operative time, lymph node yield, or blood loss. However, this sequence notably reduced the radical cystectomy time in the overall analysis.
Area of Science:
- Urology
- Surgical Oncology
- Oncologic Surgery
Background:
- Radical cystectomy (RC) is the standard treatment for bladder cancer.
- Pelvic lymph node dissection (PLND) is a critical component of RC.
- The optimal timing of PLND relative to RC is not well-established.
Purpose of the Study:
- To compare the outcomes of performing PLND before versus after RC.
- To evaluate the impact of PLND timing on operative parameters.
- To provide evidence for optimizing surgical procedures in bladder cancer treatment.
Main Methods:
- A systematic literature search was conducted across multiple databases (PubMed, Embase, Cochrane Central, Scopus, Google Scholar).
- Six studies involving 801 patients were included in the meta-analysis.
- Outcomes analyzed included total operative time, PLND time, RC time, lymph node yield, and estimated blood loss, using a random-effects model.
Main Results:
- No significant differences were observed in total operative time, PLND time, lymph node yield, or estimated blood loss between the two PLND timing groups.
- Performing PLND before RC was associated with a significant reduction in RC time (MD -28.89; 95% CI -42.84,-14.93; p < 0.0001).
- In robot-assisted RC (RARC) subgroup analysis, PLND before RC decreased total operative time, RC time, and estimated blood loss.
Conclusions:
- The timing of pelvic lymph node dissection relative to radical cystectomy does not significantly affect total operative time, PLND time, lymph node yield, or estimated blood loss.
- Performing PLND prior to RC may offer benefits in reducing the operative time for the cystectomy itself, particularly in robot-assisted procedures.
- Further research may be needed to fully elucidate the benefits and potential drawbacks of different PLND timings in bladder cancer surgery.
