1403 DOES THE LYMPHATIC DRAINAGE PATTERN OF THE LATERAL BLADDER WALL MAKE A BILATERAL PELVIC LYMPHADENECTOMY (PLND) UNNECESSARY IN STRICTLY LATERALLY LOCALIZED INVASIVE BLADDER CANCER? RESULTS OF A MULTIMODALITY MAPPING STUDY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111403 DOES THE LYMPHATIC DRAINAGE PATTERN OF THE LATERAL BLADDER WALL MAKE A BILATERAL PELVIC LYMPHADENECTOMY (PLND) UNNECESSARY IN STRICTLY LATERALLY LOCALIZED INVASIVE BLADDER CANCER? RESULTS OF A MULTIMODALITY MAPPING STUDY Beat Roth, Pascal Zehnder, Frederic D. Birkhaeuser, George N. Thalmann, Thomas M. Krause, and Urs E. Studer Beat RothBeat Roth Bern, Switzerland More articles by this author , Pascal ZehnderPascal Zehnder Bern, Switzerland More articles by this author , Frederic D. BirkhaeuserFrederic D. Birkhaeuser Bern, Switzerland More articles by this author , George N. ThalmannGeorge N. Thalmann Bern, Switzerland More articles by this author , Thomas M. KrauseThomas M. Krause Bern, Switzerland More articles by this author , and Urs E. StuderUrs E. Studer Bern, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1294AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To use single photon emission computed tomography (SPECT) combined with computed tomography (CT) plus intraoperative gamma probe verification to map the primary lymphatic landing sites of the of the lateral bladder wall. METHODS Clinical trial of 40 consecutive cystectomy patients with unilateral bladder cancer (≤cT3, cN0, cM0) at a single center. One day prior to surgery flexible cystoscopy-guided injection of Tc-99m nanocolloid into the non-tumor-bearing lateral bladder wall (left: n=21; right: n=19) was performed. All patients underwent SPECT-CT 3 and 6 h after injection of the radiopharmaceutical with a bladder flushing catheter in place. The SPECT-CT detected radioactive lymph nodes (LNs) were confirmed intraoperatively with a gamma probe at the time of PLND. Radioactive LNs were removed separately. A backup extended PLND was performed to preclude missed primary lymphatic landing sites. The SPECT-CT and intraoperative findings were used to generate a three-dimensional projection of each LN site. RESULTS A total of 1655 LNs (median 39 LNs per patient; range 21–83) were resected. 228 of these were radioactive (median 6 radioactive LNs per patient; range: 1–17). 193 radioactive LNs (85%) were located on the ipsilateral side of the injection and 35 (15%) on the contralateral side (external iliac 6%, obturator fossa 5%, common iliac 4%), but none in the internal iliac region. Only 11% of radioactive LNs were located cephalad to the uretero-iliac crossing. All patients had at least 1 radioactive LN on the ipsilateral side. 40% of patients had at least 1 additional radioactive LN on the contralateral side. CONCLUSIONS A unilateral PLND would have missed radioactive LNs on the contralateral side in 40% of patients. Therefore, a bilateral extended PLND including the common iliac region up to the uretero-iliac crossing is mandatory even in strictly laterally localized bladder tumors. Still, we could not detect any radioactive LNs in the contralateral internal iliac region. Therefore, contralateral PLND may be limited to the obturator fossa, external iliac and common iliac region which has influence on nerve sparing in patients who are candidates for an ileal bladder substitute. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e562 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Beat Roth Bern, Switzerland More articles by this author Pascal Zehnder Bern, Switzerland More articles by this author Frederic D. Birkhaeuser Bern, Switzerland More articles by this author George N. Thalmann Bern, Switzerland More articles by this author Thomas M. Krause Bern, Switzerland More articles by this author Urs E. Studer Bern, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...