A Meta-analysis Of Clinical Efficacy And Safety Of Radical Resection Of Prostate Cancer Combined With Pelvic Lymph Node Dissection In The Treatment Of High-risk Prostate Cancer

Objective:To compare the clinical efficacy and safety of radical resection of prostate cancer and combined with pelvic lymph node dissection in the treatment of medium-and high-risk prostate cancer through Meta-analysis,so as to provide theoretical basis for the selection of surgical treatment for medium-and high-risk prostate cancer.Methods:By searching Chinese and English databases such as CNKI,Wanfang,CBM,Pub Med,MEDLINE,EMBAS,Cochrane,OVID,And Web of Science,all clinical studies comparing the efficacy and safety of RP and RP&PLND were selected.The retrieval time of all the above databases was set from December 1999 to December 2019.Meanwhile,references related to andrology were retrieved manually.According to the inclusion and exclusion criteria set by the references,the two researchers independently screened,evaluated and extracted the retrieved references.If the data and other results are inconsistent,the two researchers can have a discussion.If the opinions still differ after discussion,the third researcher is invited to join the discussion and seek the opinion of the third researcher,so as to eliminate the differences as much as possible.In the end,Meta analysis was performed on all outcome indicators,including operative time,intraoperative blood loss,postoperative bed time,postoperative indwser time,gastrointestinal function recovery,and perioperative complication incidence.In terms of statistical software,we used the Rev Man5.3 statistical software provided by the Cochrane collaboration for data analysis.Result:In this paper,a total of 113 references were retrieved through a preliminary search of each database.Including Pub Med(19),EBSCO(35),EMBASE(43),the Cochrane library(4),(4)the CNKI,wanfang(6),CBM(2),according to the preset reference literature and exclusion criteria,the two researchers independently after sifting through seven articles were included in the study,including 2 randomized controlled clinical trials and five non randomized controlled clinical research,including the RP group 504 examples,RP&PLND group of 382 cases.Compared with the RP&PLND group,there were statistically significant differences in operation time(WMD=21.38,95%CI 7.55-35.34,P=0.002),postoperative bedtime(WMD=0.4,95%CI 0.24-0.56,P= 0.01),perioperative complication rate(OR=1.94,95%CI 1.29-2.87,P=0.001),lymph leakage rate(OR=10.60,95%CI 4.56-24.43,P= 0.0001).There were no statistically significant differences between the two methods in terms of intraoperative blood loss(WMD=16.34,95%CI-24.81-57.50,P=0.44),postoperative indwenture time(WMD=0.19,95%CI-0.60-0.98,P= 0.64),and gastrointestinal function recovery(WMD=0.15,95%CI-0.34-0.64,P=0.57).Conclusions:Through the above analysis,we can conclude that,compared with RP&PLND,RP alone has the advantages of short operation time,short postoperative bed time and low perioperative complication rate.There was no difference in intraoperative blood loss,postoperative indwelling catheter duration,and gastrointestinal function recovery.However,pelvic lymphadenectomy with RP&PLND for middle and high-risk prostate cancer patients will prolong the operation time and increase the incidence of perioperative complications,such as postoperative lymphatic leakage.With the abundance of multi-center studies and sample sizes in the future,it will be possible to better predict which of the two surgical methods will benefit the patients more.