The anatomical limits and oncological benefit of lymphadenectomy in muscle invasive bladder cancer

Guijarro, A.; Hernández, Virginia; Llorente, César García

doi:10.1016/j.acuroe.2017.04.001

Cited by 1 publication

(1 citation statement)

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“…Publications strongly suggest that all patients undergoing radical cystectomy for bladder cancer should undergo concomitant extended pelvic lymph node dissection (ePLND) because of the positive effect on correct staging and survival [5]. Although controversy surrounds PLND levels, many researchers agree that ePLND shows superior survival rates and correct staging compared to limited PLND [6,7] and superextended PLND provides no additional survival benefits due to the potential for increased operation time and patient morbidity [8]. In addition, it is reported that meticulous dissection is more important than the number of nodes removed [7,8].…”

Section: Introductionmentioning

confidence: 99%

Timing of lymphadenectomy during robot-assisted radical cystectomy: before or after cystectomy? Fifteen cases with totally intracorporeal urinary diversions.

Boğa

Ateş

2020

Videosurgery and Other Miniinvasive Techniques

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Introduction: Many publications detail the level and number of lymphadenectomies, whereas the timing of pelvic lymph node dissection (PLND) is infrequently discussed in the robot-assisted radical cystectomy (RARC) series. Aim: To determine the effects of performing PLND before or after cystectomy in totally intracorporeal RARC on operative outcomes. Material and methods: A total of 15 patients included in the study underwent RARC and intracorporeal orthotopic neobladder. Of these, 8 patients underwent PLND before cystectomy (group 1), whereas 7 underwent PLND after cystectomy (group 2). Demographic information, intraoperative data, and post-operative outcomes were recorded for each patient. Results: The mean ± SD age was 61.87 ±6.76 years. Overall mean operation time (OT) was 537.33 ±63.07 min. The mean EBL and hospitalization time were 322.33 ±69.92 ml and 13.87 ±5.2 days. The number of LN removed was 23.75 ±3.454) for group 1 and 13.71 ±6.873 for group 2 (p = 0.007). The postoperative pathological stages were: pT2(5), pT3(2), pT4(1) for group 1, pT2(4), pT3(2), pT4(1) for group 2. Surgical margins were negative in all patient. Overall complications occurred in 7 (46.6%) patients. Only the number of LN removed was statistically significant in favor of group 1 (p = 0.007). Mean follow-up was 15.87 months. Conclusions: Our initial experience with performing extended PLND (ePLND) before or after cystectomy in totally intracorporeal RARC appears to be favorable, with similar oncological results and acceptable complication rates. However, although the number of cases is too low for statistical evaluation, it seems to be advantageous to perform ePLND before cystectomy in terms of LN number and operation time.

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