Results of Radical Cystectomy and Pelvic Lymphadenectomy for Bladder Cancer with Pelvic Node Metastases

Bretheau, D; Ponthieu, A

doi:10.1159/000282872

Cited by 10 publications

(3 citation statements)

References 12 publications

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“…tosa, is a serious complication and occurs in 10% of reported cases. 10,11 The two earlier cases in our series showing local recurrence had severe urinary and bowel fistula. After having experienced these two cases, we introduced neoadjuvant therapy into the program and evaluated neoadjuvant therapy by WLCB and FNAB of the pelvic lymph nodes.…”

Section: Discussionmentioning

confidence: 67%

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University

et al. 1999

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Background: Neobladder, using the intestine, was performed after neoadjuvant therapy and total cystectomy as a treatment for invasive bladder cancer. Methods: Between January 1977 and April 1997, an ileocecal neobladder was used for 23 patients and a sigmoid neobladder was chosen for use in 32 patients. For the diagnosis of invasive bladder cancer and the evaluation of neoadjuvant therapy, we used whole-layer core biopsy (WLCB) of the bladder tumor and fine needle aspiration biopsy (FNAB) of pelvic lymph nodes after bipedal lymphography. For neoadjuvant therapy, two to four courses of internal iliac arterial infusion chemotherapy (IIA) were undertaken in 32 patients. Five patients were treated with IIA combined with 40 Gy irradiation to the pelvic space.Results: Pretreatment WLCB revealed a tumor of stage T2b or greater in 10 patients. After neoadjuvant therapy, three patients were down-staged to pT0. In five patients, pretreatment FNAB revealed pelvic lymph node metastases that were not detected by computed tomography or magnetic resonance imaging. Fine needle aspiration biopsy post-neoadjuvant therapy revealed tumor stage N0 in all patients and lymph node dissection revealed pN0 in four patients. Of the five patients who received 40 Gy irradiation, none had any postoperative complications, such as intestinal fistula or urinary leakage. Four male patients (10%) had urethral recurrence, but all were successfully treated by transurethral resection. Two patients treated prior to 1985 experienced local recurrence. Neither was treated by neoadjuvant therapy. Eight patients who died after 1985 had metastatic cancer, but none had local recurrence. None of the patients who received a sigmoid neobladder required clean intermittent catheterization or had bilateral vesico-ureteral reflux. Conclusions: Neoadjuvant therapy seems to reduce local recurrence in invasive bladder cancer. The sigmoid colon may be suitable for neobladder.

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Section: Discussionmentioning

confidence: 67%

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University

et al. 1999

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“…In the follow-up of 90 radical cystectomy patients, the 5-year survival was 22% and 38% in patients with and without lymph node involvement, respectively [8]. In another study performed on 248 radical cystectomy patients, lymph node involvement was found in 40 patients (16%), and the 5-year survival was 14 and 42% in groups with and without lymph node involvement, respectively [17]. These studies all indicate that lymph node involvement is not a good factor to use for prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in radical cystectomy affecting survival

Aglamis

Toktaş²,

Ünlüer³

et al. 2012

aoms

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IntroductionThe aim of the study was to evaluate the prognostic factors in radical cystectomy affecting survival.Material and methodsA total of 100 hundred patients were included in the study. Incontinent diversion was applied to 73 of these, and continent diversion to 27. Prospective and retrospective data of the patients were examined. The prognostic value for survival was evaluated for of lymph node involvement, tumor grade (low grade: grade 0-II, high grade: ≥ III or epidermoid carcinoma), tumor stage (low stage: stage pT0-2, high stage: stage ≥ 3a pT3a), presence of preoperative unilateral of bilateral hydronephrosis, presence of preoperative uremia (serum urea value: ≤ 60), and age (> 70 and ≤ 70 years of age) on survival were investigated. Kaplan-Meier survival analysis and Log-Rank statistical methods were used in the study.ResultsGrade, stage, uremia, and lymph node involvement had significant effects on survival (p values 0.0002, 0.03, 0.01, and 0.02, respectively). Presence of preoperative hydronephrosis and age had no statistically significant effects on survival (p values 0.8 and 0.2, respectively).ConclusionsTumor grade, tumor stage, preoperative uremia, and lymph node involvement are prognostic factors affecting survival. Advanced age and presence of preoperative hydronephrosis have no prognostic value for survival. The presence of uremia in the preoperative assessment of the patients is more important than hydronephrosis.

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“…The prognosis of the bladder cancer patients who have pelvic lymph node metastasis is poor. The 5‐year survival of these patients is reported as 7–30% 1–6 and recent works show 10‐year survival is 31–34%. 7,8 For the purpose of improving prognosis, fine needle aspiration biopsy (FNAB) on a diagnosis procedure for pelvic lymph node metastasis and multimodality therapy for positive FNAB cases were done.…”

Section: Introductionmentioning

confidence: 92%

Diagnosis and treatment of pelvic lymph node metastasis in bladder cancer

et al. 1999

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Background and Methods: Bipedal lymphography and percutaneous fine needle aspiration biopsy (FNAB) of pelvic lymph node was done in 200 patients with bladder cancer. Results: A diagnosis of metastasis to the pelvic lymph node was obtained by this method in 34 patients. Of these 34 patients, only 12 (35%) were positive or suspected of having pelvic lymph node metastasis by computed tomography. Sixteen patients (47%) had unequivocally positive or highly suspicious lymphogram and 18 patients (53%) had normal lymphogram. Seventy-eight cases, including eight FNAB-positive cases, were treated by radical cystectomy and regional lymph node dissection. Sensitivity, specificity, positive predictive value and negative predictive value of FNAB were 57, 100, 100 and 91%, respectively. Thirteen FNAB-positive M0 patients could be treated by multimodality therapy and evaluated after neoadjuvant therapy by repeated lymphography and FNAB. All were changed to N0 by FNAB after neoadjuvant therapy. In eight patients treated by total cystectomy and lymph node dissection, four had down staged to pN0 but four had one positive node. In five follow-up cases without surgery, one had recurrent pelvic lymph node metastasis 35 months later. Cause-specific survival of these patients was 76% at 5 years and 57% at 8 years.Conclusions: Pretreatment diagnosis of pelvic lymph node metastasis and multimodality therapy may improve the prognosis of regional lymph node-positive bladder cancer. Because it is difficult to diagnose pN1 using FNAB, radical operation should be performed even if neoadjuvant therapy is effective and down staging is obtained.

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Results of Radical Cystectomy and Pelvic Lymphadenectomy for Bladder Cancer with Pelvic Node Metastases

Cited by 10 publications

References 12 publications

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University

Prognostic factors in radical cystectomy affecting survival

Diagnosis and treatment of pelvic lymph node metastasis in bladder cancer

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