Laparoscopic pelvic lymph node dissection system based on preoperative primary tumour stage (T stage) by computed tomography in urothelial bladder cancer: results of a single‐institution prospective study

Abstract

What's known on the subject? and What does the study add?• Bladder cancer (BC) is a public health problem throughout the world, and now radical cystectomy (RC) has been introduced as a standard treatment for BC invading muscle and some BCs not invading muscle. Pelvic lymph node dissection (PLND) is considered an integral part of RC for its prognostic and therapeutic significance, but the extent of the PLND has not been precisely defined.• Computed tomography is considered one of the most preferable methods to assess the BC stage preoperatively because of its high sensitivity and specificity. However, there are few articles referring to CT as an aid in deciding the extent of lymphadenectomy during RC.• In the present study, we prospectively studied the clinical value of preoperative CT staging of primary tumours in deciding the extent of PLND during laparoscopic RC in the management of BC. The preliminary findings suggested that all patients with higher preoperative CT stage should be given super-extended PLND during RC. For those with lower CT stage, careful and thorough clearance of all lymphatic and adipose tissues within the true pelvis could be more helpful than super-extended PLND.

Comparison of the clinical effectiveness of 3D and 2D imaging systems for laparoscopic radical cystectomy with pelvic lymph node dissection

“…Primary tumours were graded preoperatively from CT scans. Similar to a previous study from our centre, 8 a standardized method was used to evaluate the preoperative CT T stage (CTx) of bladder cancer. Patients were divided into five categories according to their CTx stage (i.e., CT1, CT2a, CT2b, CT3b, and CT4a).…”

MiRNA-141 and miRNA-200b are closely related to invasive ability and considered as decision-making biomarkers for the extent of PLND during cystectomy

“…Agreement of collecting their urine and written informed consent have been obtained from all included patients. All patients underwent laparoscopic cystectomy accompanied by super-extended PLND as described in a previous report [ 19 ]. Their average age was 57 + 12.7 years.…”

“…Radiological tests, including chest X-ray and CT , were routinely done according to EAU guidelines [ 20 ]. Preoperative CT staging of bladder tumors was evaluated using a standardized method [ 19 ]. Histopathological examination of bladder cancer specimens and lymphatic tissues obtained during lymph node dissection was performed by experienced genitourinary pathologists.…”

ACR Appropriateness Criteria ® Pretreatment Staging of Muscle-Invasive Bladder Cancer

“…Yuan et al [25], in a prospective study of 63 patients, showed that CT T-stage could help surgeons determine the extent of pelvic lymph node dissection required, with lower-stage tumors requiring less extensive nodal dissection, reducing the risk of complications. A study by Horn et al [26] found that the sensitivity of CT imaging for the detection of lymph node metastases was low, although high values for specificity were achieved.…”