MP65-01 PELVIC LYMPH NODE DISSECTION ON THE CONTRALATERAL SIDE CAN BE LIMITED IN STRICTLY UNILATERALLY LOCATED BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2015MP65-01 PELVIC LYMPH NODE DISSECTION ON THE CONTRALATERAL SIDE CAN BE LIMITED IN STRICTLY UNILATERALLY LOCATED BLADDER CANCER Bernhard Kiss, Michael Paerli, Daniel Schöndorf, George N. Thalmann, and Beat Roth Bernhard KissBernhard Kiss More articles by this author , Michael PaerliMichael Paerli More articles by this author , Daniel SchöndorfDaniel Schöndorf More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Beat RothBeat Roth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2291AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Dynamic multimodality lymph node (LN) mapping showed contralateral lymphatic drainage of the lateral bladder in 40% of patients but without evidence of drainage to the contralateral internal iliac region. Due to the substantial impact of these findings on nerve sparing in radical cystectomy we evaluated whether patho-anatomical findings confirm these dynamic imaging results in patients with strictly unilaterally located bladder cancer. METHODS Between 01/2000 and 07/2013 825 bladder cancer patients without evidence of LN involvement (cN0) underwent extended pelvic LN dissection (PLND), radical cystectomy, and urinary diversion at our institution. 193/825 (23%) of these cN0 patients turned out to be LN positive in the pathological specimen (pN+). 26% (51/193 patients) of this subgroup had strictly unilaterally located bladder cancer. The distribution of LN involvement in these patients was retrospectively analyzed. RESULTS The median number of LNs removed per patient was 35 (range 13-80). The median number of positive LNs was 2 (range 1-14). Fourteen of 51 patients (31%) presented with LN metastases on the contralateral side (total positive contralateral LNs:18; median 1 LN per patient; range 1-3). 72% (13/18) of the positive contralateral LNs were located in the external iliac, 17% (3/18) in the obturator, and 11% (2/18) in the common iliac region. There was no positive LN found in the contralateral internal iliac region. Five of 51 patients (10%) showed LN metastases only in contralateral external and common nodes without evidence of LN metastases in the ipsilateral pelvis. CONCLUSIONS Crossover lymphatic drainage is a common phenomenon and unilateral PLND would have missed LN metastases in 31% of patients. However, our patho-anatomic mapping study confirms the results of dynamic multimodality LN mapping showing no lymphatic drainage to the contralateral internal iliac region. Thus, if bladder cancer is strictly unilaterally located, contralateral pelvic lymph node dissection can be limited to the obturator fossa, and the external and common iliac regions. Consequently, preserving the contralateral autonomic nerves situated close and medial to the internal iliac vessels does not compromise surgical radicality. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e807 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bernhard Kiss More articles by this author Michael Paerli More articles by this author Daniel Schöndorf More articles by this author George N. Thalmann More articles by this author Beat Roth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...