Extent of Pelvic Lymphadenectomy and Its Impact On Outcome in Patients Diagnosed With Bladder Cancer: Analysis of Data From the Surveillance, Epidemiology and End Results Program Data Base

Abstract

These results indicate significantly increased survival rates after cystectomy in patients with bladder cancer diagnosed with stages III or IV disease who have relatively more lymph nodes examined, suggesting that even some with higher stage disease may benefit from extended pelvic lymphadenectomy at cystectomy.

Lymph node density: surrogate marker for quality of resection in bladder cancer?

“…To further confound matters, the anatomic extent of node dissection and number of nodes retrieved varies widely between surgeons and institutions. Limited node dissections occur despite the well-documented potential for cure and evidence suggesting that complete node dissection may have a greater impact on survival than adjuvant chemotherapy [3]. In one prospective study, only the anatomic extent of node dissection (limited vs standard vs For reprint orders, please contact reprints@future-drugs.com extended) was associated with significant differences in nodal yield [7].…”

“…Since up to 25% of patients undergoing radical cystectomy have nodal metastases and 30% of patients with nodepositive disease may be cured by surgery, complete removal of disease burden requires a thorough nodal dissection [1,2]. Further support for a thorough node dissection at cystectomy is demonstrated by the fact that even N0 patients demonstrate improved survival if more (> nine in this reference) nodes are removed, presumably through the elimination of micrometastatic disease [3]. Surprisingly though, analysis of the Surveillance Epidemiology and End Results (SEER) registry revealed 40.3% of patients who undergo cystectomy do not undergo a lymph node dissection and, overall, 67.9% have fewer than six nodes removed [3].…”

“…LND has been demonstrated to be directly correlated with recurrence-free survival [3][4][5][6]. In a recent review, LND was found to be a better surrogate end point than total number of positive nodes in four out of five studies in the literature evaluated by Herr [14].…”

“…Further support for a thorough node dissection at cystectomy is demonstrated by the fact that even N0 patients demonstrate improved survival if more (> nine in this reference) nodes are removed, presumably through the elimination of micrometastatic disease [3]. Surprisingly though, analysis of the Surveillance Epidemiology and End Results (SEER) registry revealed 40.3% of patients who undergo cystectomy do not undergo a lymph node dissection and, overall, 67.9% have fewer than six nodes removed [3]. This raises the following questions:…”

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

“…Data from large ORC series have categorically shown that a good pelvic lymph node dissection is both diagnostic and improves overall survival [17][18][19]. The incidence of node positivity at the time of radical cystectomy exceeds 20%, and corresponds to increasing pathological stage, grade, and differentiation of bladder tumor.…”