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Abstract

We appreciate this editorial comment and agree with the issues raised. Although the benefits of pelvic lymphadenectomy have been demonstrated time and again, an evidence-based determination of the extent of dissection remains elusive. The question of surgical dissection limits is inherent to oncological surgery, and it would be difficult to identify a malignancy in which the tug-and-pull of more versus less surgery has not been widely debated to define the minimal extent of surgery with best possible outcomes. Over a century ago, William Halsted commented on the extent of node dissection at the time of radical mastectomy: “I fail to see why the neck involvement in itself is more serious than the axilla area. The neck can be cleaned out as thoroughly as the axilla.” 1 Halsted W.S. A clinical and histological study of certain adenocarcinomata of the breast: and a brief consideration of the supraclavicular operation and of the results of operation for cancer of the breast from 1889 to 1898 at the Johns Hopkins Hospital. Ann Surg. 1898; 28: 557-576 PubMed Google Scholar Yet, the question is not what is feasible but what is beneficial. Editorial CommentUrologyVol. 80Issue 3PreviewThe relationship between lymph node (LN) count and survival in patients undergoing radical cystectomy for bladder cancer continues to be a point of discussion. Several studies have shown that LN count correlates with recurrence and survival. Intuitively this makes sense—removal of micrometastatic disease should improve survival in patients with clinically LN-negative disease and presumably from removal of disease in patients with low volume nodal metastases. The authors examined this relationship by identifying and controlling for key confounding variables in a large population-based cohort and found that nodal count indeed correlates with survival in node-negative patients but not in node-positive patients. Full-Text PDF