Lymphadenectomy for Bladder Cancer

Abstract

Experience with lymph node dissection in breast and colon cancer established the potential curability in patients whose tumor had spread to regional lymph nodes. Urologists began routinely including pelvic lymphadenectomy (PLND) with total cystectomy in the early 1930s, resulting in a significant decrease in local recurrence with acceptable morbidity and m~rtali ty.~,’~ Leadbetter and Cooper” meticulously applied the rationale of the Wertheim operation for carcinoma of the cervix, which included removal of the external and internal iliac as well as the common iliac lymph nodes along with a total hysterectomy. Jewett and Strong’s observations’ that pelvic nodal metastases occur in the absence of distant disease further supported the rationale for including PLND at the time of radical cystectomy. Long-term survival was observed in patients with small volume nodal metastases,22 and survival data from several contemporary series indicate that up to 53% of patients with small volume nodal disease potentially are curable.”