ABSTRACT
A study by Clark et al21 appears to support those who consider standard dissection to be adequate. They performed a randomized prospective evaluation of extended versus limited lymph node dissection in 100 patients with clinically localized prostate cancer and found no difference between these two groups concerning metastatic disease. However, they did describe a significantly higher rate of complications after extended versus lymph node dissection in 123. This study, although addressing an important subject, does have some limitations, which may explain why the findings are in contrast to most other studies. The number of patients is too small to test for equivalence. In the low-risk patient groups, the majority would not have required lymph node dissection, which further limits the power of the trial. In addition, the researchers randomly assigned patients to extended lymph-adenectomy on one side only, independent of tumor localization, thus introducing a large risk of lymph node dissection on the non-tumor-bearing side. They also did not define the pathologic work-up or the number of nodes removed.
