1029 CHANGE IN PATHOLOGICAL N-STAGE ASSOCIATED WITH EXTENDED LYMPH NODE DISSECTION AND RADICAL CYSTECTOMY IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER

Abstract

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 20101029 CHANGE IN PATHOLOGICAL N-STAGE ASSOCIATED WITH EXTENDED LYMPH NODE DISSECTION AND RADICAL CYSTECTOMY IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER Guilherme Godoy, Lambros Stamatakis, Robert Freundlich, Guoqing Chen, Anuja Mital, Jeffrey Shoss, Ramiro Madden-Fuentes, Bumshik Hong, and Seth P. Lerner Guilherme GodoyGuilherme Godoy More articles by this author , Lambros StamatakisLambros Stamatakis More articles by this author , Robert FreundlichRobert Freundlich More articles by this author , Guoqing ChenGuoqing Chen More articles by this author , Anuja MitalAnuja Mital More articles by this author , Jeffrey ShossJeffrey Shoss More articles by this author , Ramiro Madden-FuentesRamiro Madden-Fuentes More articles by this author , Bumshik HongBumshik Hong More articles by this author , and Seth P. LernerSeth P. Lerner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2064AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate how the extent of lymph node dissection (LND) affects N-stage and the completeness of removing all potential regional lymph node (LN) metastasis, we analyzed patients treated with a consistent surgical approach with extended LND (eLND) in order to determine the incremental benefit to staging in patients with urothelial carcinoma of the bladder. METHODS From our Institutional Review Board-approved database we identified 320 evaluable patients who had undergone radical cystectomy and eLND performed by a single surgeon (SPL) between 1992 and 2009. All patients had LND that included the standard pelvic (external iliac, obturator, hypogastric) and extended template (common iliac, pre-sciatic, pre-sacral) ± LN located at or above the bifurcation of the aorta. RESULTS Median age was 67.1 (IQR 59, 74) years, with the majority being males (84.4%). pT-stage distribution was pT0-pT1=39.4%, pT2=21.2%, pT3=29.1%, and pT4=10.3%. Positive LN were observed in 78 (24.4%) patients. pN-stage distribution was pN0=75.6%, pN1=7.2%, pN2=14.4%, and pN3=2.8%. The median number of positive LN per patient was 3 (IQR 1, 6.75), with 53 (67.9%) bearing >1 +LN. Positive LN were found in the pelvic region alone in 43 (55.1%) patients (N1=23 (53.5%), N2=19 (44.2%) and N3=1 (2.3%)). 16 (20.5%) patients had positive LN in the pelvic + common iliac region (pN2=14 (87.5%) and pN3=2 (12.5%)), whereas 14 (17.9%) had positive LN in all three regions (pN2=8 (57.1%) and pN3=6 (42.9%)). There were no cases with positive LN located only in the common iliac or aortic regions. Of the 32 patients who had pelvic positive LN and additional disease in the common iliac ± aortic regions, 25% were pN3. The change in pN-stage that resulted from the extended LND (common iliac and aortic nodes) was a decrease in patients stage N1 from 53.5% to 29.5%, and an increase in N2 from 44.2% to 59% and in N3 from 2.3% to 11.5%. The increase in number of positive LN with addition of the extended regions was 12 (6.2%) to 18 (9.3%) in patients with organ-confined (pT0-2) versus 31 (24.6%) to 60 (47.6%) in patients with non-organ-confined (pT3-4) disease. CONCLUSIONS A significant number of additional positive LN was found due to the extended LND template, which would have been missed with a true pelvis only LND. There was also an increase in rates of pN2/pN3 disease when common iliac and aortic LN were added in the LND template. The incremental gain in removal of additional LN metastases is greatest for patients with non-organ-confined disease. Houston, TX© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e400 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Guilherme Godoy More articles by this author Lambros Stamatakis More articles by this author Robert Freundlich More articles by this author Guoqing Chen More articles by this author Anuja Mital More articles by this author Jeffrey Shoss More articles by this author Ramiro Madden-Fuentes More articles by this author Bumshik Hong More articles by this author Seth P. Lerner More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...