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Related Experiment Videos

Prospectively packaged lymph node dissections with radical cystectomy: evaluation of node count variability and node

Bernard H Bochner1, Daniel Cho, Harry W Herr

  • 1Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. bochnerb@mskcc.org

The Journal of Urology
|September 17, 2004
PubMed
Summary
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The extent of pelvic lymph node dissection significantly impacts lymph node yield after radical cystectomy for bladder cancer. Extended dissection increases node count but not staging accuracy. Common iliac nodes may require inclusion in dissections.

Area of Science:

  • Urology
  • Oncology
  • Surgical Pathology

Background:

  • Increased lymph node (LN) yield after radical cystectomy (RC) correlates with improved patient outcomes in bladder cancer.
  • Variability exists in the number of LNs reported, necessitating investigation into contributing factors.

Purpose of the Study:

  • To prospectively evaluate factors influencing the number of LNs reported following RC for transitional cell carcinoma of the bladder.
  • To identify predictors of LN yield and assess the impact of dissection extent.

Main Methods:

  • Prospective evaluation of 144 patients undergoing RC and pelvic lymph node dissection (PLND).
  • Lymph nodes processed individually; standard evaluation methods employed.
  • Mixed statistical model used, considering neoadjuvant chemotherapy, node status, pathological stage, BCG exposure, age, and time from resection, with surgeon and pathologist as random effects.

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Main Results:

  • Extended PLND yielded significantly more LNs (median 22.5) than standard PLND (median 8).
  • No staging advantage was observed with extended dissection.
  • Only the type of PLND performed significantly influenced node yield (p <0.001).
  • 33% of patients with unexpected microscopic nodal involvement had common iliac node involvement.

Conclusions:

  • The extent of PLND is the primary determinant of LN yield after RC.
  • Inclusion of the common iliac chain in PLND is recommended for bladder cancer cases without grossly involved LNs, given the risk of microscopic involvement.