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The Cochrane Risk of Bias 2 (RoB2) tool [10] was used to evaluate bias across five domains: randomisation process, deviations from the intended interventions, missing outcome data, measurement of the outcome and selection of the reported result

Contrary to expectations, complete lymphadenectomy in these patients did not prolong overall survival, questioning the model of a phased metastatic dissemination from primary site, to regional lymph nodes, to distant sites

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