Abstract
PurposeWe performed a retrospective analysis of patients treated with radical cystectomy and lymphadenectomy (LAD) for bladder cancer to assess the differential association of the extent of LAD with perioperative complications and re-hospitalization.Materials and methodsLAD templates were defined as limited (lLAD = external, internal iliac and obturator), extended (eLAD = up to crossing of ureter and presacral lymph nodes), and super-extended (sLAD = up to the inferior mesenteric artery). Logistic regression models investigated the association of LAD templates with intraoperative, 30- and 30–90-day postoperative complications, as well as re-hospitalizations within 30 and 30–90 days.ResultsA total of 284 patients were available for analysis. sLAD led to a higher lymph-node yield (median 39 vs 13 for lLAD and 31 for eLAD, p < 0.05) and N2/N3 status compared to lLAD and eLAD (p = 0.04). sLAD was associated with a blood loss of > 500 ml (OR 1.3, 95% CI 1.08–1.49, p = 0.003) but not with intraoperative transfusion, operation time, or length of hospital stay (p > 0.05). Overall, 11 (4%) patients were readmitted within 30 days and 50 (17.6%) within 30–90 days. The 30- and 30–90-day mortality rates were 2.8% and 1.4%, respectively. On logistic regression, LAD template was not associated with postoperative complications or re-hospitalization rates.ConclusionssLAD leads to higher lymph-node yield and N2/N3 rate but not to higher complication rate compared to lLAD and eLAD. With the advent of novel adjuvant systemic therapies, precise nodal staging will have a crucial role in patients counseling and clinical decision making.
Highlights
Radical cystectomy (RC) with lymphadenectomy (LAD), preceded by neoadjuvant chemotherapy (NAC) when possible, is the standard of care for muscle-invasive and recurrent high-risk bladder cancer (BCa) [1]
The benefits of a super-extended LAD are questioned, as lymphnode metastasis above the aortic bifurcation is uncommon and the dissection of these nodes could result in longer operative times
On multivariable analysis which adjusted for the effect of age-adjusted Charlson comorbidity index (CCI), tumor stage, body mass index (BMI), and the use of enhanced recovery after surgery (ERAS) protocol, super-extended LAD (sLAD) remained associated with a blood loss of > 500 ml
Summary
Radical cystectomy (RC) with lymphadenectomy (LAD), preceded by neoadjuvant chemotherapy (NAC) when possible, is the standard of care for muscle-invasive and recurrent high-risk bladder cancer (BCa) [1]. The benefits of a super-extended LAD (sLAD) are questioned, as lymphnode metastasis above the aortic bifurcation is uncommon and the dissection of these nodes could result in longer operative times. The association of a more extensive LAD template with perioperative complications has not been sufficiently assessed, to our knowledge. Results from a recent randomized trial failed to show any significant differences in 30- and 90-day complications rates between extended LAD (eLAD) and sLAD [10]. We hypothesized that a more extended LND would be associated with a higher rate of intra- and postoperative complications, length of stay, and re-admissions. We performed a detailed analysis of perioperative complications and investigated their association with different LAD templates.
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