scholarly journals The Adequacy of Pelvic Lymphadenectomy During Radical Cystectomy for Carcinoma Urinary Bladder: A Narrative Review of Literature

2021 ◽  
Vol 8 ◽  
Author(s):  
Rahul Jena ◽  
Nikita Shrivastava ◽  
Aditya Prakash Sharma ◽  
Gautam Ram Choudhary ◽  
Aneesh Srivastava

An adequate pelvic lymph node dissection (PLND) is an essential part of radical cystectomy for muscle invasive bladder cancer. However, the definition of what constitutes an adequate PLND is often shrouded in controversy. Various authors have defined different anatomic templates of PLND based on levels of pelvic lymph nodes. Some have suggested other surrogate markers of the adequacy of PLND, namely lymph node count and lymph node density. While individual studies have shown the efficacy and reliability of some of the above markers, none of them have been recommended forthright due to the absence of robust prospective data. The use of non-standardized nomenclature while referring to the above variables has made this matter more complex. Most of older data seems to favor use of extended template of PLND over the standard template. On the other hand, one recent randomized controlled trial (RCT) did not show any benefit of one template over the other in terms of survival benefit, but the study design allowed for a large margin of bias. Therefore, we conducted a systematic search of literature using EMBASE, Medline, and PubMed using PRISMA-P checklist for articles in English Language published over last 20 years. Out of 132 relevant articles, 47 articles were included in the final review. We have reviewed existing literature and guidelines and have attempted to provide a few suggestions toward a uniform nomenclature for the various anatomical descriptions and the extent of PLND done while doing a radical cystectomy. The results of another large RCT (SWOG S1011) are awaited and until we have a definitive evidence, we should adhere to these suggestions as much as possible and deal with each patient on a case to case basis.

2017 ◽  
pp. 95-100
Author(s):  
Luong Vinh Le ◽  
Van Tung Hoang ◽  
Ngoc khanh Tran ◽  
Thanh Liem Ngo ◽  
Dinh khanh Le

Background: For long time the standard lymphadenectomy is the part of radical cystectomy surgery for treament invasive bladder cancer. Some new research show the good result of extended pelvic lymphadenectomy in improving postoperative survival. Purpose: Report techniques and results of extended pelvic lymphadenectomy in radical cystectomy for invasive bladder cancer. Material and method: Prospective descriptive study on 38 extended pelvic lymphadenectomy patients from January 2013 to April 2017 at Hue Centre Hospital. Results: Mean of age: 63.45 ± 12.5 years old. Female/man: 3/38. Lymph nodes metastasis6/38 patients, 4 obturator lymph node positive and 2common iliac vessels lymph node positive. Mean time of pelvic lymphadenectomy: 78 ± 43 mins. Mean of blood loss: 120 ± 55ml. Mean of lymph node count: 13 ± 4. Conclusion: Extended pelvic lymphadenectomy should be perform for all patients radical cystectomy to improve postoperative survival and It is safe when perform at a good surgery centre with experienced surgeon. Key words: Extended pelvic lymphadenectomy; invasive bladder cancer; Radical cystectomy


2021 ◽  
Vol 10 (21) ◽  
pp. 4923
Author(s):  
Artur Lemiński ◽  
Krystian Kaczmarek ◽  
Wojciech Michalski ◽  
Bartosz Małkiewicz ◽  
Katarzyna Kotfis ◽  
...  

Radical cystectomy (RC) with pelvic lymph node dissection (PLND) remains the mainstay of treatment for muscle-invasive bladder cancer (MIBC). The extent of PLND and number of removed lymph nodes (LNs) have been associated with improved staging and survival outcomes in several series of RC patients. Neoadjuvant chemotherapy (NAC) has become standard of care for cisplatin-eligible patients qualified to RC, yet few studies on PLND stratified cases according to the receipt of NAC. We aimed to address this issue and reevaluate the prognostic value of PLND nodal yields in series of patients who underwent RC on the verge of the NAC era. This single-center, retrospective, clinical follow-up study enrolled 439 consecutive patients, out of whom 83 received NAC. We analyzed survival outcome of RC according to the number of removed nodes between NAC and non-NAC subgroups. We found PLND thresholds of 10 and 15 LNs prognostically meaningful in our study cohort, and this association was particularly pronounced in the non-NAC subgroup. Higher numbers of LNs provided a 25% reduction in risk of all-cause mortality and correspondingly correlated with up to a 14% increase in 3-year overall survival. The receipt of NAC diminished the benefit of adequate PLND, as the number of retrieved LNs was not associated with survival in the NAC-RC cohort. Given the limitations of our study, additional research is needed to verify these findings.


2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Ramy F. Youssef ◽  
Ganesh V. Raj

Radical cystectomy with pelvic lymphadenectomy represents the gold standard for treatment of muscle-invasive bladder cancer. Extent of the lymph node dissection and lymph node involvement during radical cystectomy are the most powerful prognostic factors associated with poor oncological outcome. However, the optimal boundaries of the lymph node dissection during a radical cystectomy are controversial. The published literature based mostly on retrospective studies suggests that increasing the number of nodes excised may have therapeutic and diagnostic benefits without significantly increasing the surgical morbidity. These conclusions are, however, influenced by selection and surgeon biases, inconsistencies in the quality of the surgery, and node count variability. In this paper, we establish the current understanding about the utility of lymphadenectomy during a radical cystectomy for muscle-invasive bladder cancer.


2012 ◽  
Vol 11 (1) ◽  
pp. e600-e600a
Author(s):  
P. Zehnder ◽  
S. Daneshmand ◽  
E.C. Skinner ◽  
U.E. Studer ◽  
G. Miranda ◽  
...  

2002 ◽  
Vol 167 (2 Part 1) ◽  
pp. 651-651
Author(s):  
R.D. Mills ◽  
W.H. Turner ◽  
A. Fleischmann ◽  
R. Markwalder ◽  
G.N. Thalmann ◽  
...  

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