Meta-analysis Of The Efficacy And Safety Of Extended Versus Non-extended Lymph Node Dissection During Radical Cystectomy In Patients With Bladder Cancer

OBJECTIVE:To investigate the efficacy and safety of two surgical procedures,extended lymph node dissection and non-extended lymph node dissection,in patients with bladder cancer using Meta-analysis.METHODS:A comprehensive search was conducted on CNKI,CQVIP,Wanfang,CBM,Embase,Web of science,Cochrane Library,Pubmed,looking for studies comparing extended lymph node dissection in radical cystectomy with non-extended lymph node dissection from the time of database construction to January 2023 lymph node dissection,conducted literature screening and quality evaluation,included relevant studies,and performed Meta-analysis to assess the effects of different lymph node dissection modalities on recurrence-free survival(RFS),cancer-specific survival(CSS),disease-free survival(DFS),overall survival(OS),operative time,intraoperative bleeding,and postoperative complication rates.RESULTS:A total of 20 publications containing 5581 patients were included,including2589 cases of extended lymph node dissection and 2992 cases of non-extended lymph node dissection.Meta-analysis showed that there was no statistically significant difference in operative time,intraoperative bleeding,postoperative complications and90-day admission rate between the two groups.5-year recurrence-free survival[HR=0.61,95% CI(0.57.0.67),P<0.00001],5-year cancer-specific survival[HR=0.57,95%CI(0.44,0.75),P<0.0001],5-year disease-free survival [HR=0.66,95% CI(0.52,0.82),P=0.0003] and overall survival [HR=0.75,95% CI(0.66.0.84),P<0.00001] were statistically significant in comparison.CONCLUSION:In patients with bladder cancer who underwent radical cystectomy,extended lymph node dissection did not significantly affect the amount of intraoperative bleeding or the incidence of postoperative complications,implying that extended lymph node dissection is a safe treatment approach that does not increase the surgical risk for patients.In addition,the treatment effect of extended lymph node dissection in patients with bladder cancer was more definite;specifically,extended lymph node dissection improved DFS,RFS,CSS,and OS of patients.