Removal of more lymph nodes may provide better outcome, as well as more accurate pathologic findings, in patients with bladder cancer—analysis of role of pelvic lymph node dissection

Honma, Ichiya; Masumori, Naoya; Sato, Eiji; Maeda, Toshihiro; Hirobe, Megumi; Kitamura, Hiroshi; Takahashi, Atsushi; Itoh, Naoki; Tamakawa, Mitsuharu; Tsukamoto, Taiji

doi:10.1016/j.urology.2006.03.049

Cited by 38 publications

(36 citation statements)

References 16 publications

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“…This study included 7 patients who received neoadjuvant chemotherapy for clinical CT3bN0-2 disease, and only one patient showed a pathologically confirmed complete response in the level I LN (Table 3). Previously we reported that neoadjuvant chemotherapy did not influence the number of LNs removed [13]. Therefore, we consider the bias resulting from inclusion of patients who received neoadjuvant chemotherapy as minimal.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, we have not yet analyzed the survival benefit of extended PLND because of the short follow-up period. Several investigators suggested that more LNs retrieved during PLND could provide longer survival even in patients with node-positive disease [8,13,[21][22][23]. Extended PLND is considered to allow not only for more accurate staging but also for removal of undetected micrometastases [24].…”

Section: } }mentioning

confidence: 99%

“…Recent retrospective series [8][9][10] have suggested that extended lymphadenectomy provides not only a diagnostic but also a survival benefit, probably by removing undetected micrometastases [11,12]. There may also be a survival benefit of PLND in patients with nodepositive diseases [13].…”

Section: Introductionmentioning

confidence: 99%

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Lymph node metastasis mapping in extended lymphadenectomy to the level of the inferior mesenteric artery for bladder cancer

et al. 2011

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Lymph node metastasis mapping in extended lymphadenectomy to the level of the inferior mesenteric artery for bladder cancer

et al. 2011

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“…In another recent study, among patients with nodal involvement found at cystectomy, removal of at least 13 nodes was associated with improved disease-specific survival; moreover, those who had Ͻ 4 nodes positive but had removal of Ͻ13 nodes had outcomes comparable to those with a more extended lymphadenectomy and found to have at least 4 nodes positive [27]. Finally, Koppie et al analyzed 1,121 cystectomy patients, with a median of 9 nodes removed (range 0 -53).…”

Section: Nodal Yield/adequacy Of Lymphadenectomymentioning

confidence: 94%

Candidate quality of care indicators for localized bladder cancer

Cooperberg

Porter

Konety

2009

Urologic Oncology: Seminars and Original Investigations

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The surgical management of clinically localized bladder cancer is challenging, and the quality of care delivered to patients with bladder cancer is a subject of increasing interest. Multiple large studies have examined the association between surgical volume and outcomes after radical cystectomy. These studies generally find lower mortality and complication rates at high-volume centers, though interpretation of the data must be tempered by limitations of the datasets driving the studies. Benefits of regionalization of care also must be weighed against other measures proven to predict outcomes; a delay in time to cystectomy beyond 3 months, for example, is strongly associated with increased mortality. Other candidate process measures supported by existing literature include adequacy of lymphadenectomy as measured by nodal yield and availability or offering of orthotopic diversion when appropriate. Assessment and reporting of bladder cancer outcomes should be risk adjusted based on oncologic risk factors and patient comorbid illness. Perioperative morbidity and mortality, cause-specific survival, and overall survival are all key measures. Assessment of health-related quality of life after bladder cancer treatment should also be standardized for reporting. Multiple survey instruments have been developed in recent years, but none has yet been well validated or widely adopted. In particular, capturing variation in quality of life outcomes between patients undergoing bladder-sparing protocols vs. continent diversion vs. incontinent diversion is an important but difficult goal that has not yet been met. The urologic oncology community should take a strong lead in achieving consensus regarding the definition, assessment, and reporting of quality of care data for bladder cancer.

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“…Honma et al reported that patients with less than four positive nodes had a statistically significant survival advantage compared with four or more positive nodes, and the number of nodes removed has a significant impact on diseasespecific survival in node-positive patients. The removal of 13 or more nodes had a survival benefit even in the node-positive patients [29]. If pelvic nodal involvement is proven, it should be considered a manifestation of a systemic disease.…”

Section: The Importance Of the Number Of Positive Lymph Nodesmentioning

confidence: 99%

Lymphadenectomy in Muscle Invasive Bladder Cancer

Horsanalı¹,

Ozer²

2017

Bladder Cancer - Management of NMI and Muscle-Invasive Cancer

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Bladder cancer is the second most common genitourinary malignancy with urothelial cancer comprising nearly 90% of primary bladder tumors. Urothelial carcinoma of the urinary bladder is the fifth most common malignancy in the United States, with an estimated 76,960 new cases and 163,900 deaths in 2016. Radical cystectomy with lymph node dissection remains the standard treatment for patients with muscle-invasive urothelial carcinoma of the bladder, and also for nonmuscle-invasive disease, refractory to intravesical therapy. The current approaches to pelvic lymph node dissections are based on the removal of lymph nodes most commonly harboring metastatic disease, notably the external iliac, obturator, and hypogastric lymph nodes. The boundaries for a standard pelvic lymph node dissection generally include the bifurcation of the common iliac vessels superiorly and the genitofemoral nerve laterally. Extended pelvic lymph node includes the removal of lymph nodes between the bifurcation of the common iliac vessels and the level of the aortic bifurcation, sometimes including distal aortic and caval nodes up to the level of the inferior mesenteric artery, as well as presacral nodes. Extended and superextended dissection has been reported to be associated with superior survival outcome.

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Removal of more lymph nodes may provide better outcome, as well as more accurate pathologic findings, in patients with bladder cancer—analysis of role of pelvic lymph node dissection

Cited by 38 publications

References 16 publications

Lymph node metastasis mapping in extended lymphadenectomy to the level of the inferior mesenteric artery for bladder cancer

Lymph node metastasis mapping in extended lymphadenectomy to the level of the inferior mesenteric artery for bladder cancer

Candidate quality of care indicators for localized bladder cancer

Lymphadenectomy in Muscle Invasive Bladder Cancer

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