Extended Radical Lymphadenectomy in Patients With Urothelial Bladder Cancer:: Results of a Prospective Multicenter Study
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- 1 January 2004
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 171 (1), 139-144
- https://doi.org/10.1097/01.ju.0000102302.26806.fb
Abstract
Previous studies demonstrate a positive correlation between postoperative survival and the extent of pelvic lymphadenectomies in patients with bladder cancer. However, the distribution of nodal metastases has not been examined in sufficient detail. Therefore, we conducted a comprehensive prospective analysis of lymph node metastases to obtain precise knowledge about the pattern of lymphatic tumor spread. Between 1999 and 2002 we performed 290 radical cystectomies and extended lymphadenectomies. Cranial border of the lymphadenectomy was the level of the inferior mesenteric artery, lateral border was the genitofemoral nerve and caudal border was the pelvic floor. We made every effort to excise and examine microscopically all lymph nodes from 12 well-defined anatomical locations. Mean total number and standard deviation of lymph nodes removed was 43.1 +/- 16.1. Nodal metastases were present in 27.9% of patients. The percentage of metastases at different sites ranged from 14.1% (right obturator nodes) to 2.9% (right paracaval nodes above the aortic bifurcation). By studying cases of unilateral primary tumors or with only 1 metastasis we observed a preferred pattern of metastatic spread. However, there were many exceptions to the rule and we did not identify a well-defined sentinel lymph node. We strongly recommend extended radical lymphadenectomy to all patients undergoing radical cystectomy for bladder cancer to remove all metastatic tumor deposits completely. The operation can be conducted in routine clinical practice and our data may serve as a guideline for future standardization and quality control of the procedure.This publication has 13 references indexed in Scilit:
- Pathologic evaluation of radical cystectomy specimensCancer, 2002
- IMPACT OF THE NUMBER OF LYMPH NODES RETRIEVED ON OUTCOME IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCERJournal of Urology, 2002
- IMPACT OF SEPARATE VERSUS EN BLOC PELVIC LYMPH NODE DISSECTION ON THE NUMBER OF LYMPH NODES RETRIEVED IN CYSTECTOMY SPECIMENSJournal of Urology, 2001
- Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosisBJU International, 2000
- RADICAL CYSTECTOMY: EXTENDING THE LIMITS OF PELVIC LYMPH NODE DISSECTION IMPROVES SURVIVAL FOR PATIENTS WITH BLADDER CANCER CONFINED TO THE BLADDER WALLJournal of Urology, 1998
- Radical Cystectomy for Carcinoma of the Bladder: Critical Evaluation of the Results in 1,026 CasesJournal of Urology, 1997
- Anatomical Basis for Pelvic Lymphadenectomy in Prostate Cancer: Results of an Autopsy Study and Implications for the ClinicJournal of Urology, 1996
- Incidence, Extent and Location of Unsuspected Pelvic Lymph Node Metastasis in Patients Undergoing Radical Cystectomy for Bladder CancerJournal of Urology, 1987
- Pelvic Lymphadenectomy and Radical Cystectomy for Transitional Cell Carcinoma of the Bladder with Pelvic Nodal DiseaseBJU International, 1985
- Management of Invasive Bladder Cancer: A Meticulous Pelvic Node Dissection Can Make a DifferenceJournal of Urology, 1982