Prognostic value of lymph-node dissection in patients undergoing radical cystectomy following previous oncological...

To investigate the prognostic value of lymph-node dissection (LND) in patients undergoing radical cystectomy (RC) following previous oncological treatment.

Perioperative findings and recurrence patterns of 46 patients undergoing RC for bladder cancer were evaluated. Twenty-six patients underwent salvage cystectomy because of local bladder cancer recurrence following intended curative external beam radiotherapy; 20 patients underwent preoperative chemotherapy because of non-regional lymph-node metastases (10 patients), clinically fixed primary tumour (cT4b) (eight patients) or pulmonary metastases (two patients).

Difficulties with LND because of fibrous tissue were accounted in the majority of previously irradiated patients. No metastatic lymph nodes were found within the irradiation field at the time of surgery or during follow-up. Two- and 5-year disease-specific survival (DSS) was 47% and 31%, respectively. In patients undergoing preoperative chemotherapy because of lymph-node metastasis, three patients (30%) had vital tumour cells within the removed lymph-nodes. Two- and 5-year DSS was 67% and 50%, respectively. Despite preoperative chemotherapy, all patients with cT4b tumours and previously diagnosed pulmonary metastases died because of recurrent disease within 2 years.

LND in the previously irradiated pelvis may be difficult and remains controversial. Because of a high risk of vital tumours cells within the removed lymph nodes despite chemotherapy, extended LND should be performed in patients with non-regional lymph-node metastasis following preoperative chemotherapy. In patients with fixed tumours and minimal response to chemotherapy and in patients with visceral metastases, RC should be attempted for palliative reasons only.