Pelvic lymph node dissection in prostate cancer: laparoscopy is not dead | Actas Urológicas Españolas (English Edition)

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Limited PLND: I. Standard PLND: I and II. Extended PLND: I, II and IV." ] ] ] "textoCompleto" => "IntroductionProstate cancer is the most common cancer among men and the second leading cause of cancer-related death in men in the United States.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The pelvic lymph node dissection in localized prostate cancer remains the best staging method and the most accurate in detecting lymph node metastasis, despite the emergence of powerful and accurate imaging modalities such as CT scan, MRI and PET CT.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> In fact, knowledge of true lymph node status allows adequate follow-up and treatment whether it is by observation, adjuvant or salvage therapy.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>While open surgery was the standard for pelvic lymph node dissection, minimally invasive techniques (laparoscopic and robot-assisted) have emerged in order to reduce perioperative morbidities. Schuessler and colleagues developed the laparoscopic radical prostatectomy in 1992; it was standardized by Gaston in 1997.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> In May 2000, Binder et al. reported the first Laparoscopic Radical Prostatectomy (LRP) assisted by a master-slave robotic system (Da Vinci)<a class="elsevierStyleCrossRef" href="#bib0030">6</a>.Since, numerous authors have reported pros and cons for each surgical technique, and guidelines still discuss all approaches (i.e., open, laparoscopic or robotic) as acceptable treatment options. Although there are many studies comparing open, laparoscopic and robotic approaches for prostatectomy, only a few articles compare pelvic lymph node dissection approaches.This article will present the surgical technique of laparoscopic pelvic lymph node dissection (PLND); explain the complications of PLND; and offer a qualitative review of literature comparing open, laparoscopic and robotic PLND.Evidence acquisitionA comprehensive and exhaustive review of the literature was performed using MEDLINE via PubMed and Google Scholar. We considered all papers that addressed comparison between open, laparoscopic, and/or robotic pelvic lymph node dissection. Only studies published in French and English from 1990 until 1 June 2019 were considered suitable for the study. The following keywords were used along with Boolean operators: "pelvic lymph node dissection", "prostatectomy", "laparoscopic lymphadenectomy", "robot-assisted lymphadenectomy", "open lymphadenectomy". The following search strategy was used on Medline via PubMed: ("pelvic lymph node dissection") OR ("pelvic lymphadenectomy") AND ("french"[Language] OR english[Language]) AND ("1990"[Date - Publication] : "3000"[Date - Publication]) AND prostatectomy[Title]). The search query was conducted on 15 June 2019. After removal of duplicates, all of the studies were evaluated by two independent reviewers (E.H. and A.S.) and selected on the basis of their titles and abstracts. Editorials, commentaries, case reports, case series and abstracts were excluded. Manuscripts evaluating or comparing the extent of lymph node dissection in radical prostatectomy were also excluded. Full-text articles were then obtained and read. References were manually checked for any other relevant studies. We hereby describe the detailed article triage technique. Of the 591 initial papers identified, after title screening and elimination of redundant articles, 55 articles remained. After reading the abstract, the authors excluded 43 additional articles. Handsearching and searching the references of note-worthy articles added 17 articles, leaving 29 articles for review. A flow chart depicting this process is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>For each article, the following parameters were collected when applicable: number of patients, operation time, complications rate, lymph node yield, positive lymph node percentage, blood loss, hemoglobin decrease, post-operative analgesic, mean hospital stay, average return to normal activities, oral intake, obturator nerve injury, drain and lymphocele.Evidence synthesisPelvic lymph node dissection in prostate cancer: boundaries and guidelinesNumerous studies have reported the variable lymphatic drainage of the prostate gland, thus justifying the importance of the extended pelvic lymph node dissection. The lymphatic chains are the internal iliac, obturator, external iliac and presacral regions. Thus, the anatomical landmarks of the extended pelvic lymph node dissection include the nodes located over the external iliac artery and vein, the nodes within the obturator fossa located superiorly and inferiorly to the obturator nerve and the nodes medial and lateral to the internal iliac artery. This technique results in 94% of patients appropriately staged.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Cf. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Given the poor outcome of all available imaging modalities, PLND remains the most accurate staging method. Moreover, PLND is performed in patients with aggressive prostate cancer. This is determined by nomograms such as the Briganti nomogram that predict lymph node positivity in patients undergoing ePLND. Based on the European Association of Urology (EAU) guidelines, PLND should not be performed in patients with low risk prostate cancer but is mandatory in patients with high-risk prostate cancer; in patients with intermediate risk, PLND should only be performed in those with a risk of lymph node metastasis >5%.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> The National Comprehensive Cancer Network (NCCN) recommends PLND when the risk of nodal involvement is >2% by nomograms.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>A risk of nodal metastases over 5%(Briganti nomogram or Roach formula<a class="elsevierStyleCrossRef" href="#bib0050">10</a>which has been shown to be almost as accurate as the nomogram) is an indication to perform nodal sampling by an extended nodal dissection. It’s important to note the trend of omitting the PLND, which occurs up to five times more often with minimally invasive surgery than open surgery.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>Moreover, there is still insufficient quality evidence supporting oncological effectiveness of sentinel node biopsy for nodal staging. Sentinel node biopsy is therefore still considered an experimental nodal staging procedure.Complications of PLNDPLND is not an innocuous procedure, and its benefits and disadvantages should be weighed. Intraoperative complications include ureteral and vascular injury and obturator nerve lesion. Post-operative complications include lymphocele, lymphedema and venous thromboembolism. Parkin and colleagues found a major and minor complication rate of 5% and 17% respectively based on the Clavien-Dindo Classification.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> We will cite the most important complications.LymphoceleThe most common complication of PLND is lymphocele, caused by lymphatic drainage disruption and accumulation of lymph fluid.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Parkin and colleagues stated that the lymphocele rate was 3.3%. Other studies suggest that asymptomatic lymphocele appears in 27%–61% of patients<a class="elsevierStyleCrossRef" href="#bib0070">14</a> while clinically detected lymphocele after open pelvic lymph node dissection (OPLND) ranges from 4.7% to 14.8%.Briganti et al. report a 10.3% rate of lymphocele in extended lymphadenectomies vs. 4.6% for transperitoneal laparoscopic PLND (LPLND).<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Therefore, higher rates of symptomatic lymphoceles may be attributable to the extraperitoneal approach and thus the use of the laparoscopic transperitoneal approach appears to be protective against lymphocele.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> Nevertheless, the more extended the PLND is, the higher the probability of lymphocele occurrence.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>Not every lymphocele should be treated. In fact, lymphoceles should only be treated if symptomatic (urinary tract compression and irritation) or in case of secondary complications (superinfection, ileus or deep venous thrombosis).<a class="elsevierStyleCrossRef" href="#bib0020">4</a> The main reason for symptomatic lymphocele formation is failure of the peritoneum to reabsorb leaked lymph. Many lymphoceles resolve with conservative treatment. 70% of lymphoceles were absorbed within 50 days postoperatively. If they persist after 3 months, the infection rate approaches 60%.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> It should be noted that anticoagulant use may increase the risk of lymphocele formation by 6.7 times.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Treatment options for symptomatic lymphoceles include percutaneous drainage, sclerotherapy, and when these options fail laparoscopic marsupialization should be considered.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Stolzenburg<a class="elsevierStyleCrossRef" href="#bib0090">18</a> described a technique of bilateral peritoneal fenestration after extraperitoneal PLND that significantly decreases the occurrence of asymptomatic and clinically significant lymphocele formation Lebeis et al. described a surgical technique to prevent lymphocele formation by rotating, interposing and fixating the ipsilateral peritoneal flap on the bladder itself, which resulted in 0% lymphocele formation in 77 patients. Results from a randomized controlled trial are awaited.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Venous thromboembolism (VTE)VTE is a major cause of mortality after radical prostatectomy (RP)<a class="elsevierStyleCrossRef" href="#bib0015">3</a> and is known to be multifactorial. It has been discovered that lymphocele is one cause of VTE. Heinzer et al. reported that routine drainage of pelvic lymphoceles after open RP with bilateral PLND reduced the rate of VTE from 6.2% to 2.1% (P = .049).<a class="elsevierStyleCrossRef" href="#bib0100">20</a>In a retrospective study on 773 patients who underwent RP, Eiffler et al. showed that an additional PLND (in 60% of patients) was associated with more cases of VTE (1.5%) compared to RP alone (0%). BMI was the most important differentiating factor among patients who had VTE and those who did not.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> The authors went further, performing a meta-analysis showing that realizing PLND doubled the risk of VTE.Administration of antithrombotic prophylaxis reduced VTE by 40%.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Vascular injuryInjuries to the major vessels are uncommon during pelvic lymph node dissection. When necessary, experienced surgeons can use laparoscopic surgical clamps to repair injuries laparoscopically.Obturator nerve injuryObturator nerve injury is an important but rare complication of pelvic lymph node dissection.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Obturator nerve injury is usually the consequence of inadvertent clip placement, electrofulguration and complete or incomplete transection. These lesions are most often located in the obturator fossa and are often diagnosed and repaired during the operation. Laparoscopic magnification seems to allow precise nerve repair compared to the open technique.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>Open, laparoscopic or robot-assisted PLNDIt is important to mention that most of the articles concerning PLND in the treatment of prostate cancer target its extent, limits, staging and possible therapeutic role. Studies evaluating the pathological aspects and complications of PLND are rare, as are comparative studies on PLND and open, laparoscopic and robot-assisted techniques.Study characteristicsIn this study, eight articles were found adequate for review. They were considered eligible because they were comparative and evaluated pathological aspects, perioperative variables and complications of pelvic lymph node dissection. Four studies compared laparoscopic and open lymph node dissection, three compared open, laparoscopic and robotic pelvic lymph node dissection and only one compared laparoscopic and robotic PLND. The age range was comparable with a mean age of 65 without any further details about patients’ comorbidities except for BMI, which was mentioned in two studies, and obesity percentage, which was mentioned in one. Manuscripts excluded from this review were those that were not comparative, those evaluating PLND in patients with conditions other than prostate cancer, those evaluating the extent and benefit of PLND and those written in languages other than French and English.Study resultsLaparoscopic lymph node dissection was initially described by Schuessler and Winfield in 1991.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>Kerbl et al. (1993) compared 30 patients who underwent laparoscopic lymph node dissection to 16 patients who underwent open surgery. The main outcomes included operation time, which was doubled in laparoscopic surgery (199.41 vs. 102.4 min in ORP), and complication rate, which was significantly higher in laparoscopic surgery with 13.3 vs. 0%. However, laparoscopy showed lower blood loss rates, less post-operative analgesic use (1.55 vs. 47 mg.), a lower mean hospital stay (1.7 vs. 5.37 days) and a lower average number of days it took patients to return to normal activities (4.94 vs. 42.9 days). A thorough assessment of the complication rate denotes the importance of the learning curve in laparoscopy; in fact, major complications occurred only in the first 12 patients.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>Lezin et al. (1997) compared LPLND to mini-laparotomy in 44 patients. They evaluated operative time, which was significantly shorter with mini-lap (a mean of 1.2 h vs. a mean of 2.9 h). The mean initial hospital stay was 1 day for mini-lap and 1.6 days for lap; the complication rate was 9.1% for mini-lap and 31.8% for lap. Lymph node invasion was noted in 45% of mini-lap patients and 27% of lap patients. The authors found two advantages of mini-lap: it is more cost-effective and has less morbidity than laparoscopic technique.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>Solberg et al. (2003) compared the frequency of lymphocele formation in 132 patients who underwent PLND, concluding that LPLND was associated with a statistically significant lower frequency of lymphocele formation compared to OPLND (61% of patients in the OPLND group vs. 38% of patients in the LPLND group). Nevertheless, only three patients developed clinically significant lymphoceles, all of them in the OPLND group.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>A retrospective comparative analysis by Bodin et al. (2011) on 115 patients who underwent LPLND and 36 patients who underwent OPLND showed no significant statistical difference when it came to vascular lesions (7 vs. 3%), obturator nerve lesion (1 vs. 0), drainage (3 vs. 2.5 days), and hospital stay (4.5 vs. 4.8 days) in laparoscopic vs. open PLND. Nevertheless, blood loss (12.09 vs. 105.6 cm3) was less in laparoscopic surgery but the intervention duration (132 vs. 103.7 min.) and lymph node number (5.73 vs. 7.2) favored the open technique. In order to eliminate the learning curve effect, the 36 patients who underwent open surgery were compared to the last 36 patients in the laparoscopy group; no difference was found between those two groups.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>In a retrospective study, Silberstein and colleagues (2012) compared the lymph node yield in the three surgical approaches. The mean number of lymph nodes was not significantly different among the three approaches (ORP 20, LRP 19, Robot Assisted Laparoscopic Prostatectomy (RALP) 16). Regarding lymphocele rate, it was low in all three groups: 1/126, 1% in the ORP group; 2/77, 3% in the LRP group; and 4/120, 3% in the RALP group. No nerve injury was reported in any of the groups.<a class="elsevierStyleCrossRefs" href="#bib0135">27, 28</a>In a matched-paired analysis of 140 patients who underwent laparoscopic and robot-assisted PLND, Albissini and colleagues reported that the number of lymph nodes extracted was higher in the robotic approach: 18 (14–23) compared to 12 (10–14) in laparoscopic procedures. Nevertheless, laparoscopy showed a lower operation time (205 vs. 245 min.) and less blood loss (200 vs. 300 mL) compared to the robotic approach.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>Luciani et al. compared the surgical outcomes of radical prostatectomy (RP) performed with three different approaches: open, laparoscopic-assisted and robot-assisted. The median number of the lymph nodes removed was 9 in open prostatectomy, 10 in LRP, and 20 in RARP groups.Van Huele et al. (2018) compared minimally invasive PLND (laparoscopic and robotic- assisted techniques) to open surgery. The authors compared 219 cases of PLND (50 done with open surgery, 96 laparoscopically and 73 with robot assistance). The operation time was longer in minimally invasive PLND (130 vs. 102 min.) with no significant difference between minimally invasive techniques. These techniques showed a lower complication rate (4.3 vs. 22%), a higher lymph node yield (15 vs. 11.5), a lower hemoglobin decrease (1.19 vs. 1.63 g.) and a lower mean hospital stay (2 vs. 5 days) compared to open surgery. Moreover, when comparing laparoscopic technique results to robotic-assisted results, significant difference was only noted in lymph node (LN) number, with 14 LN in laparoscopy and 18.5 in robotic-assisted.<a class="elsevierStyleCrossRef" href="#bib0150">30</a>Although no randomized clinical trials are available, data from prospective cohort studies comparing survival of pN + patients show that RP may have a survival benefit over abandonment of RP in node-positive cases.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> As a consequence, there is no role for performing a frozen section examination of suspicious LNs as cited by the EAU 2019 guidelines. It is also important to mention some concepts about salvage lymph node dissection. Novel imaging modalities improve the early detection of nodal metastases and the surgical management of (recurrent) nodal metastases in the pelvis has been the topic of several retrospective analyses. The majority of treated patients showed BCR but clinical recurrence-free and CSS 10-year survival over 70% has been reported. Neither the template nor the real value of nodal salvage dissection is available. It must, however, be remembered that the imaging modalities under-evaluate the real nodal involvement. Biochemical recurrence rates were found to be dependent on PSA, depending on surgery, location and number of positive nodes. Addition of RT to the lymphatic template after salvage LND may improve the BCR rate. The real efficacy of this salvage procedure remains unproven, as is its impact on the patient’s survival.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Cost effectivenessThe expense of the various PLND surgical approaches is rarely compared or discussed in the literature. However, the authors did compare the cost-effectiveness of ORP, LRP, and RALP. Bolenz et al. criticized the increasing use of RALP without objective proof of its cost-effectiveness, insisting on the necessity of an economic and cost-effectiveness assessment before worldwide adoption and replacement of standard techniques.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> The LAPPRO trial (2018) done in Sweden found a lower cost of ORP compared to RALP.<a class="elsevierStyleCrossRef" href="#bib0165">33</a> In a study done in the United States, Bolenz et al. (2010) found that direct cost of the procedure was higher for RALP ($6752) compared to LRP ($5687) or ORP ($4437); this difference was primarily due to the surgical supply and the operating room cost. Moreover, RALP increased the overall cost by $2698 per patient, due to the cost of purchase and robot maintenance with an average of 126 patients per year; its effect on the burden of prostate cancer care is therefore quite substantial.<a class="elsevierStyleCrossRef" href="#bib0160">32</a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the results of the review.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>DiscussionWith the low but increasing rate of publication in this area, the overall methodological quality of the evidence identified through this qualitative literature review remains low (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Minimally invasive vs. open approachPerioperative outcomesThis review clearly reveals the benefit of minimally invasive surgery in both laparoscopy and robot-assisted over open surgery in PLND in prostate cancer. Although the operative time of the laparoscopic groups was longer than that of the open groups, the laparoscopic groups had less intraoperative blood loss and shorter postoperative hospital stays than the open group. A possible explanation is that during laparoscopy, the positive abdominal pressure due to pneumoperitoneum reduces bleeding. Another explanation is that laparoscopy offers a clear surgical field and magnification of the narrow and deep pelvic cavity, allowing secured accurate hemostasis and a clear, detailed view of the anatomy.Oncologic outcomesThe pathological parameters evaluating the quality of laparoscopic PLND in prostate cancer included the number of lymph nodes extracted. Although some early studies<a class="elsevierStyleCrossRef" href="#bib0135">27</a> favored the open technique showing more lymph node yield, Van Huele et al. reported a higher lymph node count with minimally invasive techniques with no difference between robot-assisted and conventional laparoscopy.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> Surgical skill improvement could explain the increasing number of lymph nodes removed with time. Moreover, most of the surgeons performing PLND with a minimally invasive technique have a transperitoneal approach. This gives them closer access to blood vessels, allowing them to extract a greater number of lymph nodes. Conversely, surgeons are limited by their extraperitoneal approach in open PLND.Laparoscopic vs. robot-assisted approachThe data shows comparable results between laparoscopic and robot-assisted techniques in mean hospital stay, blood loss and lymph node yield.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> Laparoscopic PLND takes less time than the robot-assisted technique, as shown by Albissini et al.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> This is explained by lengthy set-up times for robotic procedures.The most striking drawback of robotics is the cost, with a cost analysis in favor of standard laparoscopy.In this review, a clear benefit of minimally invasive techniques over open surgery exists. But with the growing popularity of the robotic approach, a question remains: is robotic better than conventional laparoscopy? The superiority of the robot-assisted approach has been proven in some types of complicated surgery in various surgical fields including partial nephrectomy in urology. However, conventional laparoscopy showed comparable outcomes to robotic surgery in less complicated surgeries like radical nephrectomy, adrenalectomy and pyeloplasty. Pelvic lymph node dissection appears to fall in the category of less complex surgeries; considering oncological outcome, perioperative outcome and complication rate, robot assistance shows no benefits compared to conventional laparoscopy. Additionally, laparoscopy had a clear financial benefit.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>LimitationsThis review has some limitations. First, all included studies are non-RCT: they are either retrospective studies, cohort studies or matched pair analyses. Second, there is a great degree of heterogeneity in the patient selection in each study and the expertise and qualification of the surgeons, which may alter the results. The included literature is limited to studies published in English or French; this may have caused a selection bias in this review.ConclusionLaparoscopic pelvic lymph node dissection in prostate cancer is a minimally invasive procedure with short operative time, minimal blood loss, low level of pain, short hospital stay and an acceptable cost. In terms of perioperative outcomes and complications, it is superior to the open surgical approach and comparable to the robot-assisted technique, but it is more cost-effective than the latter.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1431875" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Context" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Acquisition of evidence" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Evidence Synthesis" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1307201" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1431876" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Contexto" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Adquisición de la evidencia" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Síntesis de la evidencia" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1307200" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Evidence acquisition" ] 1 => array:3 [ "identificador" => "sec0015" "titulo" => "Evidence synthesis" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Pelvic lymph node dissection in prostate cancer: boundaries and guidelines" ] ] ] ] ] 5 => array:3 [ "identificador" => "sec0025" "titulo" => "Complications of PLND" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Lymphocele" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Venous thromboembolism (VTE)" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Vascular injury" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Obturator nerve injury" ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Open, laparoscopic or robot-assisted PLND" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Study characteristics" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Study results" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Cost effectiveness" ] 8 => array:3 [ "identificador" => "sec0070" "titulo" => "Discussion" "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0075" "titulo" => "Minimally invasive vs. open approach" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Perioperative outcomes" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "Oncologic outcomes" ] ] ] 1 => array:2 [ "identificador" => "sec0090" "titulo" => "Laparoscopic vs. robot-assisted approach" ] 2 => array:2 [ "identificador" => "sec0095" "titulo" => "Limitations" ] ] ] 9 => array:2 [ "identificador" => "sec0100" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0105" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-03" "fechaAceptado" => "2020-06-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1307201" "palabras" => array:3 [ 0 => "Pelvic lymph node dissection" 1 => "Prostate cancer" 2 => "Laparoscopy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1307200" "palabras" => array:3 [ 0 => "Disección de ganglios linfáticos pélvicos" 1 => "Cáncer de próstata" 2 => "Laparoscopia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ContextPelvic lymph node dissection (PLND) in localized prostate cancer is feasible through an open, laparoscopic or robot-assisted approach. Data comparing the three approaches is sparse. ObjectiveTo perform a review in order to compare the effectiveness of the different PLND approaches. Acquisition of evidenceA search was performed including the following words: ("pelvic lymph node dissection") OR ("pelvic lymphadenectomy") AND ("french"[Language] OR english[Language]) AND ("1990"[Date - Publication]: "3000"[Date - Publication]) AND prostatectomy[Title]). Twenty-nine articles were finally included in the qualitative synthesis. Evidence SynthesisLaparoscopic pelvic lymph node dissection in prostate cancer is a minimally invasive procedure with a relatively short operative time, minimal blood loss, lower level of pain, shorter hospital stay, and fewer perioperative complications when compared to an open approach. This technique is more cost-effective than a robot-assisted approach. ConclusionConcerning the treatment of localized prostate cancer, laparoscopic pelvic lymph node dissection should be learned and applied by urologists." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Context" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Acquisition of evidence" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Evidence Synthesis" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ContextoLa disección de los ganglios linfáticos pélvicos (DGLP) en el cáncer de próstata localizado es viable mediante un abordaje abierto, laparoscópico o asistido por robot. La información sobre la comparación de los tres enfoques es escasa. ObjetivoRealizar una revisión para comparar la efectividad de los diferentes enfoques de DGLP. Adquisición de la evidenciaSe realizó una búsqueda incluyendo las siguientes palabras: ("disección de ganglios linfáticos pélvicos") o ("linfadenectomía pélvica") y ("francés" [Idioma] o inglés [Idioma]) y ("1990" [Fecha - Publicación]: "3000" [Fecha - Publicación]) y prostatectomía [Título]). Finalmente, se incluyeron 29 artículos en la síntesis cualitativa. Síntesis de la evidenciaAl compararla con un abordaje abierto, la linfadenectomía pélvica laparoscópica en el cáncer de próstata es un procedimiento mínimamente invasivo con un tiempo operatorio relativamente corto, un sangrado mínimo, un nivel más bajo de dolor, una estancia hospitalaria más corta y menos complicaciones perioperatorias. Esta técnica es más rentable que el abordaje asistido por robot. ConclusiónLa linfadenectomía pélvica laparoscópica debe ser conocida e implementada por los urólogos para el tratamiento del cáncer de próstata localizado." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Contexto" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Adquisición de la evidencia" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Síntesis de la evidencia" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Semaan A, El Helou E, Abi Tayeh G, Mjaess G, Abi Chebel J, Sarkis J. Disección de los ganglios linfáticos pélvicos en el cáncer de próstata: la laparoscopia no ha muerto. Actas Urol Esp. 2020;44:682–691." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2046 "Ancho" => 2508 "Tamanyo" => 308993 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flow chart of the review." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1508 "Ancho" => 2508 "Tamanyo" => 390988 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Boundaries of pelvic lymph node dissection subdivided into different regions. Limited PLND: I. Standard PLND: I and II. Extended PLND: I, II and IV." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients, n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Operation Time \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complication rate \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lymph Node Yield \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive lymph node percentage \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Blood Loss \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hb decrease \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Post-Operative Analgesic \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean hospital stay \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Average return to normal activities \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Oral Intake \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Obturator nerve injury \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drain \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lymphocele \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kerbl et al.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 L 16 O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">199.41 v/s 102.4 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 v/s 0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.55 v/s 47 mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7 v/s 5.37 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.94 v/s 42.9 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.63 v/s 2.87 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lezin et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 L 22 O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9 v/s 1.2 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.8 v/s 9.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 v/s 45% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 v/s 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bodin et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 L 115 O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">103.7 v/s 132.8 min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.2 v/s 33.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.73 v/s7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.1 v/s 105 mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 v/s 4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 v/s 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 v/s 2.5d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Silberstein et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">126 O 78 L 136 R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 O 19 L 16R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1% O 3% L 3% R \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Solberg et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 O 38 L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61% O 37% L \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Albissini et al.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 L 70 R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">205 v/s 245 min. L/R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/7 L v/s 1.5/7 R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 v/s 18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">200 v/s 300 mL L/ R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/70 1/70 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Luciani et al.<a class="elsevierStyleCrossRef" href="#bib0175">35</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 O 100 L 100R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 v/s10 v/s 20 ( O-l-R) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Van Huele et al.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 O 96 L 73R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130 v/s 102(MI/O) No dif (L/R) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3 v/s 22% (MI/ O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- 1.19 v/s -1.63 g/d (MI/ O) No dif (L/R) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 v/s 5d (MI/O) No dif (L/R) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2461528.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Studies evaluating the perioperative outcome and complications of open, laparoscopic and robot assisted pelvic lymph node dissection in prostate cancer." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">First Author/ Year \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Type \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total Patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laparoscopic \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Open \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Robotic \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean age L \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean Age O \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean Age R \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age range L \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age Range O \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age Range R \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidities \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BMI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kerbl et al.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55−79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48−76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lezin et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bodin et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obese 16%L 11%O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Silberstein et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">330 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">126 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">126 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.1−68.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.9−65.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.6−67.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Solberg et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">132 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56−74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50−70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Albissini et al.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective Matched pair analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56−66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64−70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.6 L 26.9R \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Luciani et al.<a class="elsevierStyleCrossRef" href="#bib0175">35</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">300 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64−73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69−77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63−71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Van Huele et al.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">219 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63−75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67−74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67−77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.7 L 27.1 O 25.6 R \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2461527.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Population characteristics in 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Pelvic lymph node dissection in prostate cancer: laparoscopy is not dead

Disección de los ganglios linfáticos pélvicos en el cáncer de próstata: la laparoscopia no ha muerto

A. Semaana,b,

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albertsemaan9180@gmail.com

Corresponding author.

, E. El Heloua,b, G. Abi Tayeha,b, G. Mjaessb, J. Abi Chebela,b, J. Sarkisa,b

a Departamento de Urología, Hotel-Dieu de France, Beirut, Líbano

b Facultad de Medicina, Universidad de Saint Joseph, Beirut, Líbano

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minimally invasive techniques &#40;laparoscopic and robot-assisted&#41; have emerged in order to reduce perioperative morbidities&#46; Schuessler and colleagues developed the laparoscopic radical prostatectomy in 1992&#59; it was standardized by Gaston in 1997&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In May 2000&#44; Binder et al&#46; reported the first Laparoscopic Radical Prostatectomy &#40;LRP&#41; assisted by a master-slave robotic system &#40;Da Vinci&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Since&#44; numerous authors have reported pros and cons for each surgical technique&#44; and guidelines still discuss all approaches &#40;i&#46;e&#46;&#44; open&#44; laparoscopic or robotic&#41; as acceptable treatment options&#46; Although there are many studies comparing open&#44; laparoscopic and robotic approaches for prostatectomy&#44; only a few articles compare pelvic lymph node dissection approaches&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This article will present the surgical technique of laparoscopic pelvic lymph node dissection &#40;PLND&#41;&#59; explain the complications of PLND&#59; and offer a qualitative review of literature comparing open&#44; laparoscopic and robotic PLND&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Evidence acquisition</span><p id="par0025" class="elsevierStylePara elsevierViewall">A comprehensive and exhaustive review of the literature was performed using MEDLINE via PubMed and Google Scholar&#46; We considered all papers that addressed comparison between open&#44; laparoscopic&#44; and&#47;or robotic pelvic lymph node dissection&#46; Only studies published in French and English from 1990 until 1 June 2019 were considered suitable for the study&#46; The following keywords were used along with Boolean operators&#58; &#34;pelvic lymph node dissection&#34;&#44; &#34;prostatectomy&#34;&#44; &#34;laparoscopic lymphadenectomy&#34;&#44; &#34;robot-assisted lymphadenectomy&#34;&#44; &#34;open lymphadenectomy&#34;&#46; The following search strategy was used on Medline via PubMed&#58; &#40;&#34;pelvic lymph node dissection&#34;&#41; OR &#40;&#34;pelvic lymphadenectomy&#34;&#41; AND &#40;&#34;french&#34;&#91;Language&#93; OR english&#91;Language&#93;&#41; AND &#40;&#34;1990&#34;&#91;Date - Publication&#93; &#58; &#34;3000&#34;&#91;Date - Publication&#93;&#41; AND prostatectomy&#91;Title&#93;&#41;&#46; The search query was conducted on 15 June 2019&#46; After removal of duplicates&#44; all of the studies were evaluated by two independent reviewers &#40;E&#46;H&#46; and A&#46;S&#46;&#41; and selected on the basis of their titles and abstracts&#46; Editorials&#44; commentaries&#44; case reports&#44; case series and abstracts were excluded&#46; Manuscripts evaluating or comparing the extent of lymph node dissection in radical prostatectomy were also excluded&#46; Full-text articles were then obtained and read&#46; References were manually checked for any other relevant studies&#46; We hereby describe the detailed article triage technique&#46; Of the 591 initial papers identified&#44; after title screening and elimination of redundant articles&#44; 55 articles remained&#46; After reading the abstract&#44; the authors excluded 43 additional articles&#46; Handsearching and searching the references of note-worthy articles added 17 articles&#44; leaving 29 articles for review&#46; A flow chart depicting this process is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">For each article&#44; the following parameters were collected when applicable&#58; number of patients&#44; operation time&#44; complications rate&#44; lymph node yield&#44; positive lymph node percentage&#44; blood loss&#44; hemoglobin decrease&#44; post-operative analgesic&#44; mean hospital stay&#44; average return to normal activities&#44; oral intake&#44; obturator nerve injury&#44; drain and lymphocele&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Evidence synthesis</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Pelvic lymph node dissection in prostate cancer&#58; boundaries and guidelines</span><p id="par0035" class="elsevierStylePara elsevierViewall">Numerous studies have reported the variable lymphatic drainage of the prostate gland&#44; thus justifying the importance of the extended pelvic lymph node dissection&#46; The lymphatic chains are the internal iliac&#44; obturator&#44; external iliac and presacral regions&#46; Thus&#44; the anatomical landmarks of the extended pelvic lymph node dissection include the nodes located over the external iliac artery and vein&#44; the nodes within the obturator fossa located superiorly and inferiorly to the obturator nerve and the nodes medial and lateral to the internal iliac artery&#46; This technique results in 94&#37; of patients appropriately staged&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Cf&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Given the poor outcome of all available imaging modalities&#44; PLND remains the most accurate staging method&#46; Moreover&#44; PLND is performed in patients with aggressive prostate cancer&#46; This is determined by nomograms such as the Briganti nomogram that predict lymph node positivity in patients undergoing ePLND&#46; Based on the European Association of Urology &#40;EAU&#41; guidelines&#44; PLND should not be performed in patients with low risk prostate cancer but is mandatory in patients with high-risk prostate cancer&#59; in patients with intermediate risk&#44; PLND should only be performed in those with a risk of lymph node metastasis &#62;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The National Comprehensive Cancer Network &#40;NCCN&#41; recommends PLND when the risk of nodal involvement is &#62;2&#37; by nomograms&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleItalic">A risk of nodal metastases over 5&#37;&#40;Briganti nomogram or Roach formula</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleItalic">which has been shown to be almost as accurate as the nomogram&#41; is an indication to perform nodal sampling by an extended nodal dissection&#46;</span> It&#8217;s important to note the trend of omitting the PLND&#44; which occurs up to five times more often with minimally invasive surgery than open surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleItalic">Moreover&#44; there is still insufficient quality evidence supporting oncological effectiveness of sentinel node biopsy for nodal staging&#46; Sentinel node biopsy is therefore still considered an experimental nodal staging procedure&#46;</span></p></span></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Complications of PLND</span><p id="par0045" class="elsevierStylePara elsevierViewall">PLND is not an innocuous procedure&#44; and its benefits and disadvantages should be weighed&#46; Intraoperative complications include ureteral and vascular injury and obturator nerve lesion&#46; Post-operative complications include lymphocele&#44; lymphedema and venous thromboembolism&#46; Parkin and colleagues found a major and minor complication rate of 5&#37; and 17&#37; respectively based on the Clavien-Dindo Classification&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> We will cite the most important complications&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Lymphocele</span><p id="par0050" class="elsevierStylePara elsevierViewall">The most common complication of PLND is lymphocele&#44; caused by lymphatic drainage disruption and accumulation of lymph fluid&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Parkin and colleagues stated that the lymphocele rate was 3&#46;3&#37;&#46; Other studies suggest that asymptomatic lymphocele appears in 27&#37;&#8211;61&#37; of patients<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> while clinically detected lymphocele after open pelvic lymph node dissection &#40;OPLND&#41; ranges from 4&#46;7&#37; to 14&#46;8&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Briganti et al&#46; report a 10&#46;3&#37; rate of lymphocele in extended lymphadenectomies vs&#46; 4&#46;6&#37; for transperitoneal laparoscopic PLND &#40;LPLND&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Therefore&#44; higher rates of symptomatic lymphoceles may be attributable to the extraperitoneal approach and thus the use of the laparoscopic transperitoneal approach appears to be protective against lymphocele&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Nevertheless&#44; the more extended the PLND is&#44; the higher the probability of lymphocele occurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Not every lymphocele should be treated&#46; In fact&#44; lymphoceles should only be treated if symptomatic &#40;urinary tract compression and irritation&#41; or in case of secondary complications &#40;superinfection&#44; ileus or deep venous thrombosis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The main reason for symptomatic lymphocele formation is failure of the peritoneum to reabsorb leaked lymph&#46; Many lymphoceles resolve with conservative treatment&#46; 70&#37; of lymphoceles were absorbed within 50 days postoperatively&#46; If they persist after 3 months&#44; the infection rate approaches 60&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> It should be noted that anticoagulant use may increase the risk of lymphocele formation by 6&#46;7 times&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Treatment options for symptomatic lymphoceles include percutaneous drainage&#44; sclerotherapy&#44; and when these options fail laparoscopic marsupialization should be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Stolzenburg<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> described a technique of bilateral peritoneal fenestration after extraperitoneal PLND that significantly decreases the occurrence of asymptomatic and clinically significant lymphocele formation Lebeis et al&#46; described a surgical technique to prevent lymphocele formation by rotating&#44; interposing and fixating the ipsilateral peritoneal flap on the bladder itself&#44; which resulted in 0&#37; lymphocele formation in 77 patients&#46; Results from a randomized controlled trial are awaited&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Venous thromboembolism &#40;VTE&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">VTE is a major cause of mortality after radical prostatectomy &#40;RP&#41;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and is known to be multifactorial&#46; It has been discovered that lymphocele is one cause of VTE&#46; Heinzer et al&#46; reported that routine drainage of pelvic lymphoceles after open RP with bilateral PLND reduced the rate of VTE from 6&#46;2&#37; to 2&#46;1&#37; &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;049&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In a retrospective study on 773 patients who underwent RP&#44; Eiffler et al&#46; showed that an additional PLND &#40;in 60&#37; of patients&#41; was associated with more cases of VTE &#40;1&#46;5&#37;&#41; compared to RP alone &#40;0&#37;&#41;&#46; BMI was the most important differentiating factor among patients who had VTE and those who did not&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The authors went further&#44; performing a meta-analysis showing that realizing PLND doubled the risk of VTE&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Administration of antithrombotic prophylaxis reduced VTE by 40&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Vascular injury</span><p id="par0095" class="elsevierStylePara elsevierViewall">Injuries to the major vessels are uncommon during pelvic lymph node dissection&#46; When necessary&#44; experienced surgeons can use laparoscopic surgical clamps to repair injuries laparoscopically&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Obturator nerve injury</span><p id="par0100" class="elsevierStylePara elsevierViewall">Obturator nerve injury is an important but rare complication of pelvic lymph node dissection&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Obturator nerve injury is usually the consequence of inadvertent clip placement&#44; electrofulguration and complete or incomplete transection&#46; These lesions are most often located in the obturator fossa and are often diagnosed and repaired during the operation&#46; Laparoscopic magnification seems to allow precise nerve repair compared to the open technique&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Open&#44; laparoscopic or robot-assisted PLND</span><p id="par0105" class="elsevierStylePara elsevierViewall">It is important to mention that most of the articles concerning PLND in the treatment of prostate cancer target its extent&#44; limits&#44; staging and possible therapeutic role&#46; Studies evaluating the pathological aspects and complications of PLND are rare&#44; as are comparative studies on PLND and open&#44; laparoscopic and robot-assisted techniques&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Study characteristics</span><p id="par0110" class="elsevierStylePara elsevierViewall">In this study&#44; eight articles were found adequate for review&#46; They were considered eligible because they were comparative and evaluated pathological aspects&#44; perioperative variables and complications of pelvic lymph node dissection&#46; Four studies compared laparoscopic and open lymph node dissection&#44; three compared open&#44; laparoscopic and robotic pelvic lymph node dissection and only one compared laparoscopic and robotic PLND&#46; The age range was comparable with a mean age of 65 without any further details about patients&#8217; comorbidities except for BMI&#44; which was mentioned in two studies&#44; and obesity percentage&#44; which was mentioned in one&#46; Manuscripts excluded from this review were those that were not comparative&#44; those evaluating PLND in patients with conditions other than prostate cancer&#44; those evaluating the extent and benefit of PLND and those written in languages other than French and English&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Study results</span><p id="par0115" class="elsevierStylePara elsevierViewall">Laparoscopic lymph node dissection was initially described by Schuessler and Winfield in 1991&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Kerbl et al&#46; &#40;1993&#41; compared 30 patients who underwent laparoscopic lymph node dissection to 16 patients who underwent open surgery&#46; The main outcomes included operation time&#44; which was doubled in laparoscopic surgery &#40;199&#46;41 vs&#46; 102&#46;4&#8239;min in ORP&#41;&#44; and complication rate&#44; which was significantly higher in laparoscopic surgery with 13&#46;3 vs&#46; 0&#37;&#46; However&#44; laparoscopy showed lower blood loss rates&#44; less post-operative analgesic use &#40;1&#46;55 vs&#46; 47&#8239;mg&#46;&#41;&#44; a lower mean hospital stay &#40;1&#46;7 vs&#46; 5&#46;37 days&#41; and a lower average number of days it took patients to return to normal activities &#40;4&#46;94 vs&#46; 42&#46;9 days&#41;&#46; A thorough assessment of the complication rate denotes the importance of the learning curve in laparoscopy&#59; in fact&#44; major complications occurred only in the first 12 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Lezin et al&#46; &#40;1997&#41; compared LPLND to mini-laparotomy in 44 patients&#46; They evaluated operative time&#44; which was significantly shorter with mini-lap &#40;a mean of 1&#46;2&#8239;h vs&#46; a mean of 2&#46;9&#8239;h&#41;&#46; The mean initial hospital stay was 1 day for mini-lap and 1&#46;6 days for lap&#59; the complication rate was 9&#46;1&#37; for mini-lap and 31&#46;8&#37; for lap&#46; Lymph node invasion was noted in 45&#37; of mini-lap patients and 27&#37; of lap patients&#46; The authors found two advantages of mini-lap&#58; it is more cost-effective and has less morbidity than laparoscopic technique&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Solberg et al&#46; &#40;2003&#41; compared the frequency of lymphocele formation in 132 patients who underwent PLND&#44; concluding that LPLND was associated with a statistically significant lower frequency of lymphocele formation compared to OPLND &#40;61&#37; of patients in the OPLND group vs&#46; 38&#37; of patients in the LPLND group&#41;&#46; Nevertheless&#44; only three patients developed clinically significant lymphoceles&#44; all of them in the OPLND group&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">A retrospective comparative analysis by Bodin et al&#46; &#40;2011&#41; on 115 patients who underwent LPLND and 36 patients who underwent OPLND showed no significant statistical difference when it came to vascular lesions &#40;7 vs&#46; 3&#37;&#41;&#44; obturator nerve lesion &#40;1 vs&#46; 0&#41;&#44; drainage &#40;3 vs&#46; 2&#46;5 days&#41;&#44; and hospital stay &#40;4&#46;5 vs&#46; 4&#46;8 days&#41; in laparoscopic vs&#46; open PLND&#46; Nevertheless&#44; blood loss &#40;12&#46;09 vs&#46; 105&#46;6&#8239;cm<span class="elsevierStyleSup">3</span>&#41; was less in laparoscopic surgery but the intervention duration &#40;132 vs&#46; 103&#46;7&#8239;min&#46;&#41; and lymph node number &#40;5&#46;73 vs&#46; 7&#46;2&#41; favored the open technique&#46; In order to eliminate the learning curve effect&#44; the 36 patients who underwent open surgery were compared to the last 36 patients in the laparoscopy group&#59; no difference was found between those two groups&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In a retrospective study&#44; Silberstein and colleagues &#40;2012&#41; compared the lymph node yield in the three surgical approaches&#46; The mean number of lymph nodes was not significantly different among the three approaches &#40;ORP 20&#44; LRP 19&#44; Robot Assisted Laparoscopic Prostatectomy &#40;RALP&#41; 16&#41;&#46; Regarding lymphocele rate&#44; it was low in all three groups&#58; 1&#47;126&#44; 1&#37; in the ORP group&#59; 2&#47;77&#44; 3&#37; in the LRP group&#59; and 4&#47;120&#44; 3&#37; in the RALP group&#46; No nerve injury was reported in any of the groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44; 28</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">In a matched-paired analysis of 140 patients who underwent laparoscopic and robot-assisted PLND&#44; Albissini and colleagues reported that the number of lymph nodes extracted was higher in the robotic approach&#58; 18 &#40;14&#8211;23&#41; compared to 12 &#40;10&#8211;14&#41; in laparoscopic procedures&#46; Nevertheless&#44; laparoscopy showed a lower operation time &#40;205 vs&#46; 245&#8239;min&#46;&#41; and less blood loss &#40;200 vs&#46; 300&#8239;mL&#41; compared to the robotic approach&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Luciani et al&#46; compared the surgical outcomes of radical prostatectomy &#40;RP&#41; performed with three different approaches&#58; open&#44; laparoscopic-assisted and robot-assisted&#46; The median number of the lymph nodes removed was 9 in open prostatectomy&#44; 10 in LRP&#44; and 20 in RARP groups&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Van Huele et al&#46; &#40;2018&#41; compared minimally invasive PLND &#40;laparoscopic and robotic- assisted techniques&#41; to open surgery&#46; The authors compared 219 cases of PLND &#40;50 done with open surgery&#44; 96 laparoscopically and 73 with robot assistance&#41;&#46; The operation time was longer in minimally invasive PLND &#40;130 vs&#46; 102&#8239;min&#46;&#41; with no significant difference between minimally invasive techniques&#46; These techniques showed a lower complication rate &#40;4&#46;3 vs&#46; 22&#37;&#41;&#44; a higher lymph node yield &#40;15 vs&#46; 11&#46;5&#41;&#44; a lower hemoglobin decrease &#40;1&#46;19 vs&#46; 1&#46;63&#8239;g&#46;&#41; and a lower mean hospital stay &#40;2 vs&#46; 5 days&#41; compared to open surgery&#46; Moreover&#44; when comparing laparoscopic technique results to robotic-assisted results&#44; significant difference was only noted in lymph node &#40;LN&#41; number&#44; with 14&#8239;LN in laparoscopy and 18&#46;5 in robotic-assisted&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Although no randomized clinical trials are available&#44; data from prospective cohort studies comparing survival of pN&#8239;&#43;&#8239;patients show that RP may have a survival benefit over abandonment of RP in node-positive cases&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> As a consequence&#44; there is no role for performing a frozen section examination of suspicious LNs as cited by the EAU 2019 guidelines&#46; It is also important to mention some concepts about salvage lymph node dissection&#46; Novel imaging modalities improve the early detection of nodal metastases and the surgical management of &#40;recurrent&#41; nodal metastases in the pelvis has been the topic of several retrospective analyses&#46; The majority of treated patients showed BCR but clinical recurrence-free and CSS 10-year survival over 70&#37; has been reported&#46; Neither the template nor the real value of nodal salvage dissection is available&#46; It must&#44; however&#44; be remembered that the imaging modalities under-evaluate the real nodal involvement&#46; Biochemical recurrence rates were found to be dependent on PSA&#44; depending on surgery&#44; location and number of positive nodes&#46; Addition of RT to the lymphatic template after salvage LND may improve the BCR rate&#46; The real efficacy of this salvage procedure remains unproven&#44; as is its impact on the patient&#8217;s survival&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Cost effectiveness</span><p id="par0165" class="elsevierStylePara elsevierViewall">The expense of the various PLND surgical approaches is rarely compared or discussed in the literature&#46; However&#44; the authors did compare the cost-effectiveness of ORP&#44; LRP&#44; and RALP&#46; Bolenz et al&#46; criticized the increasing use of RALP without objective proof of its cost-effectiveness&#44; insisting on the necessity of an economic and cost-effectiveness assessment before worldwide adoption and replacement of standard techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> The LAPPRO trial &#40;2018&#41; done in Sweden found a lower cost of ORP compared to RALP&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> In a study done in the United States&#44; Bolenz et al&#46; &#40;2010&#41; found that direct cost of the procedure was higher for RALP &#40;&#36;6752&#41; compared to LRP &#40;&#36;5687&#41; or ORP &#40;&#36;4437&#41;&#59; this difference was primarily due to the surgical supply and the operating room cost&#46; Moreover&#44; RALP increased the overall cost by &#36;2698 per patient&#44; due to the cost of purchase and robot maintenance with an average of 126 patients per year&#59; its effect on the burden of prostate cancer care is therefore quite substantial&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the results of the review&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">With the low but increasing rate of publication in this area&#44; the overall methodological quality of the evidence identified through this qualitative literature review remains low &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Minimally invasive vs&#46; open approach</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Perioperative outcomes</span><p id="par0180" class="elsevierStylePara elsevierViewall">This review clearly reveals the benefit of minimally invasive surgery in both laparoscopy and robot-assisted over open surgery in PLND in prostate cancer&#46; Although the operative time of the laparoscopic groups was longer than that of the open groups&#44; the laparoscopic groups had less intraoperative blood loss and shorter postoperative hospital stays than the open group&#46; A possible explanation is that during laparoscopy&#44; the positive abdominal pressure due to pneumoperitoneum reduces bleeding&#46; Another explanation is that laparoscopy offers a clear surgical field and magnification of the narrow and deep pelvic cavity&#44; allowing secured accurate hemostasis and a clear&#44; detailed view of the anatomy&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Oncologic outcomes</span><p id="par0185" class="elsevierStylePara elsevierViewall">The pathological parameters evaluating the quality of laparoscopic PLND in prostate cancer included the number of lymph nodes extracted&#46; Although some early studies<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> favored the open technique showing more lymph node yield&#44; Van Huele et al&#46; reported a higher lymph node count with minimally invasive techniques with no difference between robot-assisted and conventional laparoscopy&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Surgical skill improvement could explain the increasing number of lymph nodes removed with time&#46; Moreover&#44; most of the surgeons performing PLND with a minimally invasive technique have a transperitoneal approach&#46; This gives them closer access to blood vessels&#44; allowing them to extract a greater number of lymph nodes&#46; Conversely&#44; surgeons are limited by their extraperitoneal approach in open PLND&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Laparoscopic vs&#46; robot-assisted approach</span><p id="par0190" class="elsevierStylePara elsevierViewall">The data shows comparable results between laparoscopic and robot-assisted techniques in mean hospital stay&#44; blood loss and lymph node yield&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Laparoscopic PLND takes less time than the robot-assisted technique&#44; as shown by Albissini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> This is explained by lengthy set-up times for robotic procedures&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The most striking drawback of robotics is the cost&#44; with a cost analysis in favor of standard laparoscopy&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In this review&#44; a clear benefit of minimally invasive techniques over open surgery exists&#46; But with the growing popularity of the robotic approach&#44; a question remains&#58; is robotic better than conventional laparoscopy&#63; The superiority of the robot-assisted approach has been proven in some types of complicated surgery in various surgical fields including partial nephrectomy in urology&#46; However&#44; conventional laparoscopy showed comparable outcomes to robotic surgery in less complicated surgeries like radical nephrectomy&#44; adrenalectomy and pyeloplasty&#46; Pelvic lymph node dissection appears to fall in the category of less complex surgeries&#59; considering oncological outcome&#44; perioperative outcome and complication rate&#44; robot assistance shows no benefits compared to conventional laparoscopy&#46; Additionally&#44; laparoscopy had a clear financial benefit&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Limitations</span><p id="par0205" class="elsevierStylePara elsevierViewall">This review has some limitations&#46; First&#44; all included studies are non-RCT&#58; they are either retrospective studies&#44; cohort studies or matched pair analyses&#46; Second&#44; there is a great degree of heterogeneity in the patient selection in each study and the expertise and qualification of the surgeons&#44; which may alter the results&#46; The included literature is limited to studies published in English or French&#59; this may have caused a selection bias in this review&#46;</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conclusion</span><p id="par0210" class="elsevierStylePara elsevierViewall">Laparoscopic pelvic lymph node dissection in prostate cancer is a minimally invasive procedure with short operative time&#44; minimal blood loss&#44; low level of pain&#44; short hospital stay and an acceptable cost&#46; In terms of perioperative outcomes and complications&#44; it is superior to the open surgical approach and comparable to the robot-assisted technique&#44; but it is more cost-effective than the latter&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conflict of interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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              "titulo" => "S&#237;ntesis de la evidencia"
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              "identificador" => "abst0050"
              "titulo" => "Conclusi&#243;n"
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        3 => array:2 [
          "identificador" => "xpalclavsec1307200"
          "titulo" => "Palabras clave"
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        4 => array:3 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0010"
              "titulo" => "Evidence acquisition"
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            1 => array:3 [
              "identificador" => "sec0015"
              "titulo" => "Evidence synthesis"
              "secciones" => array:1 [
                0 => array:2 [
                  "identificador" => "sec0020"
                  "titulo" => "Pelvic lymph node dissection in prostate cancer&#58; boundaries and guidelines"
                ]
              ]
            ]
          ]
        ]
        5 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Complications of PLND"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Lymphocele"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Venous thromboembolism &#40;VTE&#41;"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Vascular injury"
            ]
            3 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Obturator nerve injury"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0050"
          "titulo" => "Open&#44; laparoscopic or robot-assisted PLND"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Study characteristics"
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            1 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Study results"
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          ]
        ]
        7 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Cost effectiveness"
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          "identificador" => "sec0070"
          "titulo" => "Discussion"
          "secciones" => array:3 [
            0 => array:3 [
              "identificador" => "sec0075"
              "titulo" => "Minimally invasive vs&#46; open approach"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0080"
                  "titulo" => "Perioperative outcomes"
                ]
                1 => array:2 [
                  "identificador" => "sec0085"
                  "titulo" => "Oncologic outcomes"
                ]
              ]
            ]
            1 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Laparoscopic vs&#46; robot-assisted approach"
            ]
            2 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Limitations"
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        9 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Conclusion"
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        10 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Conflict of interest"
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        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-04-03"
    "fechaAceptado" => "2020-06-30"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1307201"
          "palabras" => array:3 [
            0 => "Pelvic lymph node dissection"
            1 => "Prostate cancer"
            2 => "Laparoscopy"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1307200"
          "palabras" => array:3 [
            0 => "Disecci&#243;n de ganglios linf&#225;ticos p&#233;lvicos"
            1 => "C&#225;ncer de pr&#243;stata"
            2 => "Laparoscopia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Context</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pelvic lymph node dissection &#40;PLND&#41; in localized prostate cancer is feasible through an open&#44; laparoscopic or robot-assisted approach&#46; Data comparing the three approaches is sparse&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To perform a review in order to compare the effectiveness of the different PLND approaches&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Acquisition of evidence</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A search was performed including the following words&#58; &#40;&#34;pelvic lymph node dissection&#34;&#41; OR &#40;&#34;pelvic lymphadenectomy&#34;&#41; AND &#40;&#34;french&#34;&#91;Language&#93; OR english&#91;Language&#93;&#41; AND &#40;&#34;1990&#34;&#91;Date - Publication&#93;&#58; &#34;3000&#34;&#91;Date - Publication&#93;&#41; AND prostatectomy&#91;Title&#93;&#41;&#46; Twenty-nine articles were finally included in the qualitative synthesis&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Evidence Synthesis</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Laparoscopic pelvic lymph node dissection in prostate cancer is a minimally invasive procedure with a relatively short operative time&#44; minimal blood loss&#44; lower level of pain&#44; shorter hospital stay&#44; and fewer perioperative complications when compared to an open approach&#46; This technique is more cost-effective than a robot-assisted approach&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Concerning the treatment of localized prostate cancer&#44; laparoscopic pelvic lymph node dissection should be learned and applied by urologists&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Context"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Acquisition of evidence"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Evidence Synthesis"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusion"
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        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Contexto</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La disecci&#243;n de los ganglios linf&#225;ticos p&#233;lvicos &#40;DGLP&#41; en el c&#225;ncer de pr&#243;stata localizado es viable mediante un abordaje abierto&#44; laparosc&#243;pico o asistido por robot&#46; La informaci&#243;n sobre la comparaci&#243;n de los tres enfoques es escasa&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Realizar una revisi&#243;n para comparar la efectividad de los diferentes enfoques de DGLP&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Adquisici&#243;n de la evidencia</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda incluyendo las siguientes palabras&#58; &#40;&#34;disecci&#243;n de ganglios linf&#225;ticos p&#233;lvicos&#34;&#41; o &#40;&#34;linfadenectom&#237;a p&#233;lvica&#34;&#41; y &#40;&#34;franc&#233;s&#34; &#91;Idioma&#93; o ingl&#233;s &#91;Idioma&#93;&#41; y &#40;&#34;1990&#34; &#91;Fecha - Publicaci&#243;n&#93;&#58; &#34;3000&#34; &#91;Fecha - Publicaci&#243;n&#93;&#41; y prostatectom&#237;a &#91;T&#237;tulo&#93;&#41;&#46; Finalmente&#44; se incluyeron 29 art&#237;culos en la s&#237;ntesis cualitativa&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">S&#237;ntesis de la evidencia</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Al compararla con un abordaje abierto&#44; la linfadenectom&#237;a p&#233;lvica laparosc&#243;pica en el c&#225;ncer de pr&#243;stata es un procedimiento m&#237;nimamente invasivo con un tiempo operatorio relativamente corto&#44; un sangrado m&#237;nimo&#44; un nivel m&#225;s bajo de dolor&#44; una estancia hospitalaria m&#225;s corta y menos complicaciones perioperatorias&#46; Esta t&#233;cnica es m&#225;s rentable que el abordaje asistido por robot&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La linfadenectom&#237;a p&#233;lvica laparosc&#243;pica debe ser conocida e implementada por los ur&#243;logos para el tratamiento del c&#225;ncer de pr&#243;stata localizado&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Contexto"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Adquisici&#243;n de la evidencia"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "S&#237;ntesis de la evidencia"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Semaan A&#44; El Helou E&#44; Abi Tayeh G&#44; Mjaess G&#44; Abi Chebel J&#44; Sarkis J&#46; Disecci&#243;n de los ganglios linf&#225;ticos p&#233;lvicos en el c&#225;ncer de pr&#243;stata&#58; la laparoscopia no ha muerto&#46; Actas Urol Esp&#46; 2020&#59;44&#58;682&#8211;691&#46;</p>"
      ]
    ]
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      0 => array:8 [
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2046
            "Ancho" => 2508
            "Tamanyo" => 308993
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the review&#46;</p>"
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      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "detalles" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Boundaries of pelvic lymph node dissection subdivided into different regions&#46; Limited PLND&#58; I&#46; Standard PLND&#58; I and II&#46; Extended PLND&#58; I&#44; II and IV&#46;</p>"
        ]
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients&#44; n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Operation Time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complication rate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lymph Node Yield&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive lymph node percentage&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Blood Loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hb decrease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Post-Operative Analgesic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean hospital stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Average return to normal activities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Oral Intake&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Obturator nerve injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drain&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lymphocele&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kerbl et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#8239;L 16 O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">199&#46;41 v&#47;s 102&#46;4&#8239;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 v&#47;s 0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;55 v&#47;s 47&#8239;mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7 v&#47;s 5&#46;37 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;94 v&#47;s 42&#46;9 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;63 v&#47;s 2&#46;87 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Silberstein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">126 O 78&#8239;L 136 R&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61&#37; O 37&#37; L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Albissini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70&#8239;L 70 R&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;70 1&#47;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Luciani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 O 100&#8239;L 100R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 v&#47;s10 v&#47;s 20 &#40; O-<span class="elsevierStyleSmallCaps">l</span>-R&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Van Huele et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 O 96&#8239;L 73R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 v&#47;s 102&#40;MI&#47;O&#41; No dif &#40;L&#47;R&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3 v&#47;s 22&#37; &#40;MI&#47; O&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- 1&#46;19 v&#47;s -1&#46;63&#8239;g&#47;d &#40;MI&#47; O&#41; No dif &#40;L&#47;R&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 v&#47;s 5d &#40;MI&#47;O&#41; No dif &#40;L&#47;R&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">First Author&#47; Year&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laparoscopic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean age L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean Age O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean Age R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age range L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age Range O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age Range R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidities&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kerbl et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#8722;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#8722;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lezin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bodin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obese 16&#37;L 11&#37;O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Silberstein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">330&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">62&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">63&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56&#46;1&#8722;68&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55&#46;9&#8722;65&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">57&#46;6&#8722;67&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Solberg et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#8722;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#8722;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Albissini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective Matched pair analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#8722;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#8722;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;6&#8239;L 26&#46;9R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Luciani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64&#8722;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">69&#8722;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#46;7&#8239;L 27&#46;1 O 25&#46;6 R&nbsp;\t\t\t\t\t\t\n
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