Lymphadenectomy before and after radical cystectomy: does this affect the radicality? A prospective randomized...

Area of Science:

• Urology
• Surgical Oncology
• Oncology

Background:

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

Purpose of the Study:

• To prospectively compare the oncological outcomes of ePLND performed before versus after RC.
• To evaluate the impact of ePLND timing on operative time, complications, and oncological failure.

Main Methods:

• A prospective randomized study of 200 patients with T2-T3b N0M0 bladder cancer.
• Group I: ePLND before RC; Group II: ePLND after RC.
• Postoperative evaluation included clinical, laboratory, and radiographic assessments.

Main Results:

• Operative time was shorter in Group II (ePLND after RC) (p=0.01).
• No significant differences in the number of lymph nodes removed, intraoperative, or postoperative complications between groups.
• Oncological failure rates were comparable: 17.6% in Group I vs. 22% in Group II (p=0.389).

Conclusions:

• ePLND before or after RC demonstrates comparable oncological outcomes.
• Disease stage, time to RC, and surgeon experience are critical factors.
• Timing of ePLND should prioritize patient factors for safe RC with minimal morbidity.