[Effects of performing pelvic lymph node dissection before versus after radical cystectomy]

Area of Science:

• Urology
• Surgical Oncology
• Oncologic Surgery

Background:

• Radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer.
• Extended pelvic lymph node dissection (e-PLND) is crucial for accurate staging and treatment.
• The optimal timing of e-PLND relative to RC remains debated.

Purpose of the Study:

• To compare the efficacy of performing e-PLND before versus after RC.
• To evaluate operative duration, lymph node yield, and complication rates based on the timing of e-PLND.

Main Methods:

• Retrospective review of 107 patients undergoing e-PLND and RC between 2003 and 2013.
• Patients were divided into two groups: RC after e-PLND (Group A) and RC before e-PLND (Group B).
• Comparison of operative duration, lymph node counts, metastatic rates, and complications using statistical tests.

Main Results:

• Operative duration for RC was significantly shorter when performed after e-PLND (Group A) compared to before (Group B) (P < 0.01).
• Mean lymph node yield was comparable, although fewer nodes were retrieved from internal iliac and presacral regions in Group A.
• Lymph node metastasis rates and operative complication rates were similar between the two groups.

Conclusions:

• Radical cystectomy is preferably performed after extended pelvic lymph node dissection.
• Dissection of the internal iliac and presacral lymph node regions after RC is recommended for maximizing lymph node retrieval.