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Outcome After Radical Cystectomy With Limited Or Extended Pelvic Lymph Node Dissection

April 04, 2017

UroToday- This article further strengthens the argument that an extended lymph node dissection improves staging accuracy and survival in patients with invasive bladder cancer. Investigators at two different institutions (Cleveland Clinic and University of Bern) evaluated their long-term outcomes after radical cystectomy and pelvic lymph node dissection. Surgeons at the Cleveland Clinic performed a limited pelvic node dissection that encompassed the nodal tissue below the common iliac artery and surgeons at the University of Bern performed an extended lymph node dissection including the common iliac and presacral nodes.

Limited and extended lymph node dissections were performed in 336 and 322 patients, respectively. All cases were staged N0M0 prior to radical cystectomy, and none were treated with neoadjuvant radiotherapy or chemotherapy. Patients with PTis/pT1 and pT4 disease were excluded from analysis. The lymph node positive rate was 13% and 26% for limited and extended lymph node dissection patients. The 5-year disease-free survival rate for lymph node positive patients was 7% and 35% in limited and extended lymph node dissection, respectively. Even for patients with node negative bladder cancer, patients with an extended lymph node dissection had a better disease-free survival. The 5-year disease-free survival for pT2N0 and pT3N0 patients undergoing a limited and extended lymph node dissection was 67% and 77%, and 23% and 57% (p