1406 EXTENDED LYMPH NODE DISSECTION IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR CANCER: HOW HIGH?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111406 EXTENDED LYMPH NODE DISSECTION IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR CANCER: HOW HIGH? Pascal Zehnder, Urs Studer, Eila Skinner, Ryan Dorin, Jie Cai, Beat Roth, Gus Miranda, John Stein, Fiona Burkhard, Sia Daneshmand, George Thalmann, Inderbir Gill, and Donald Skinner Pascal ZehnderPascal Zehnder Los Angeles, CA More articles by this author , Urs StuderUrs Studer Bern, Switzerland More articles by this author , Eila SkinnerEila Skinner Los Angeles, CA More articles by this author , Ryan DorinRyan Dorin Los Angeles, CA More articles by this author , Jie CaiJie Cai Los Angeles, CA More articles by this author , Beat RothBeat Roth Bern, Switzerland More articles by this author , Gus MirandaGus Miranda Los Angeles, CA More articles by this author , John SteinJohn Stein Los Angeles, CA More articles by this author , Fiona BurkhardFiona Burkhard Bern, Switzerland More articles by this author , Sia DaneshmandSia Daneshmand Los Angeles, CA More articles by this author , George ThalmannGeorge Thalmann Bern, Switzerland More articles by this author , Inderbir GillInderbir Gill Los Angeles, CA More articles by this author , and Donald SkinnerDonald Skinner Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1297AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) with extended pelvic lymph node dissection (LND) results in more accurate staging and better outcomes when compared with limited LND. The optimal limits of extended LND remain unclear, however. We compared oncologic outcomes from two cystectomy centers with two different extended templates to determine whether LND up the inferior mesenteric artery (IMA) takeoff may confer an additional survival advantage. METHODS Patients undergoing RC and extended LND with curative intent at the University of Southern California (USC) and the University of Bern (UB) between 1985 and 2005 were included if they met all of the following criteria: 1) Urothelial carcinoma of the bladder, 2) preoperative no evidence of metastases (cN0M0), 3) pathologic stage pT2 or pT3, 4) negative soft tissue margins, 5) no neoadjuvant therapy. Survival and recurrence data were analyzed. RESULTS 554 patients treated at USC and 405 patients treated at UB were included. Age, gender and distribution of pathological subgroups (pT2, pT3) were similar. The median number of lymph nodes (LNs) removed per patient was higher at USC (USC: 38 vs. UB: 22, p<0.0001). There was a difference in the incidence of LN metastasis (USC: 35% vs. UB: 28%, p=0.02). No differences were seen in oncologic outcomes with 5-year recurrence-free survival (RFS) (p=0.55) and overall survival (OS) (p=0.78) for pT2 N0-2 patients of 57% and 55% at USC versus 67% and 58% at UB, respectively. 5-year RFS (p=0.44) and OS (p=0.53) rates for pT3 N0-2 patients were also similar, 32% and 25% at USC and 34% and 32% at UB, respectively. The overall recurrence rate was equal at both institutions (38%). CONCLUSIONS A meticulous extended LND up to the crossing of the retracted ureters over the common iliac vessels provides similar survival and recurrence outcomes when compared to a template up to the IMA takeoff. Complete skeletonization of all structures within the extended LND template seems to be more important than total nodal yield. This does not exclude the possibility that subgroups of patients, e.g. with suspicious nodes and after neoadjuvant chemotherapy, may benefit from a more extensive LND. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e563 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pascal Zehnder Los Angeles, CA More articles by this author Urs Studer Bern, Switzerland More articles by this author Eila Skinner Los Angeles, CA More articles by this author Ryan Dorin Los Angeles, CA More articles by this author Jie Cai Los Angeles, CA More articles by this author Beat Roth Bern, Switzerland More articles by this author Gus Miranda Los Angeles, CA More articles by this author John Stein Los Angeles, CA More articles by this author Fiona Burkhard Bern, Switzerland More articles by this author Sia Daneshmand Los Angeles, CA More articles by this author George Thalmann Bern, Switzerland More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Donald Skinner Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...