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Risk to benefit ratio

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Volume 12, Number 1 Review Articles

Complications of Pelvic Lymphadenectomy: Do the Risks Outweigh the Benefits?

Treatment Review

Alan W Partin Edward M Schaeffer Stacy Loeb

The American Urological Association Best Practice Policy states that although pelvic lymph node dissection (PLND) is commonly done with radical prostatectomy, its morbidity must be considered, particularly in cases in which it offers little additional information. The benefits of PLND include more accurate staging and reassurance for the patient. In addition, PLND may be therapeutic for men with lymph node metastases and may result in long-term biochemical cure for selected node-positive patients. However, the incidence of node positivity is declining, and accordingly a greater number of lymphadenectomies must be performed to benefit 1 patient. In addition to the associated cost, PLND has the potential for morbidity, including lymphoceles, thromboembolic events, ureteral injury, and neurovascular injury. Patients and physicians should therefore assess the risk/benefit ratio associated with PLND on an individual basis to permit informed treatment decisions.[Rev Urol. 2010;12(1):20-24 doi:10.3909/riu0422]

Prostate cancer Radical prostatectomy Pelvic lymph node dissection Ureteral injury Lymph node metastases Risk to benefit ratio Lymphocele Thromboembolic events Vascular injury Nerve injury