Radical Cystectomy: Extending the Limits of Pelvic Lymph Node Dissection Improves Survival for Patients With Bladder Cancer Confined to the Bladder Wall

No AccessJournal of UrologyClinical Urology: Original Articles1 Dec 1998RADICAL CYSTECTOMY: EXTENDING THE LIMITS OF PELVIC LYMPH NODE DISSECTION IMPROVES SURVIVAL FOR PATIENTS WITH BLADDER CANCER CONFINED TO THE BLADDER WALL ASGER L. POULSEN, THOMAS HORN, and KENNETH STEVEN ASGER L. POULSENASGER L. POULSEN , THOMAS HORNTHOMAS HORN , and KENNETH STEVENKENNETH STEVEN View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62229-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assess the influence of the limits of pelvic lymph node dissection on survival following radical cystectomy for bladder cancer. Materials and Methods: From January 1990 to September 1997, 194 patients underwent radical cystectomy without prior treatment. Between March 1993 and September 1997, 126 consecutive patients underwent radical cystectomy with extended pelvic lymph node dissection beginning at the bifurcation of the aorta, including the common and external iliac vessels, presacral nodes and obturator fossa. Between January 1990 and March 1993, 68 consecutive patients underwent radical cystectomy, with limited pelvic lymph node dissection beginning at the bifurcation of the common iliac vessels, including the external iliac vessels and obturator fossa. The cystectomy procedure remained unchanged throughout this period and 1 surgeon performed all procedures. Results: A total of 117 patients had tumors confined to the bladder wall (stage pT3a or less) and 77 had tumors penetrating beyond the bladder into perivesical fat or adjacent structures (stage pT3b or greater). The prevalence of patients with tumors penetrating the bladder was higher in the extended dissection group (42.9 versus 33.8% limited dissection). The incidence of lymphatic involvement was 26.2% and slightly higher in the extended than the limited dissection group. There was a modest improvement in the 5-year recurrence-free survival for the extended dissection group (62 versus 56% limited dissection, p = 0.33), and a substantial improvement for the subgroups with tumors confined to the bladder wall (tumor stage pT3a or less) (85 versus 64%, p <0.02) and without lymph node metastasis (stage pT3a or less, pN0) (90 versus 71%, p <0.02). Accordingly, extended pelvic lymph node dissection reduced the 5-year probabilities for pelvic and distant metastasis (2 versus 7% limited dissection, p = 0.17 and 10 versus 21%, p = 0.15, respectively) for patients with tumors confined to the bladder wall (stage pT3a or less). Survival was similar for patients with pT3b or greater tumor. Conclusions: This retrospective analysis suggests that extending the limits of pelvic lymph node dissection from the bifurcation of the common iliac vessels to the bifurcation of the aorta improves the recurrence-free survival rate for patients undergoing radical cystectomy for bladder cancer confined to the bladder wall (stage pT3a or less). References 1 : Infiltrating carcinoma of the bladder: relation of depth of penetration of the bladder wall to incidence of local extension and metastases. J. Urol.1946; 55: 366. Link, Google Scholar 2 : Pelvic lymphadenectomy and total cystectomy in the treatment of carcinoma of the bladder. J. Urol.1950; 63: 842. Link, Google Scholar 3 : Radical total cystectomy for cancer of the bladder: 230 consecutive cases five years later. J. Urol.1962; 87: 853. Link, Google Scholar 4 : The value of pelvic lymphadenectomy in the surgical treatment of bladder cancer. J. Urol.1973; 109: 414. Link, Google Scholar 5 : Long-term patient survival after cystectomy for regional metastatic transitional cell carcinoma of the bladder. J. Urol.1991; 146: 36. Link, Google Scholar 6 : The rationale for en bloc pelvic lymph node dissection for bladder cancer patients with nodal metastases: long term results. J. Urol.1993; 149: 758. Link, Google Scholar 7 : Radical cystectomy for carcinoma of the bladder: critical evaluation of the results in 1,026 cases. J. Urol.1997; 158: 393. Link, Google Scholar 8 : The role of pelvic lymphadenectomy and radical cystectomy for lymph node positive bladder cancer. Cancer1994; 73: 3020. Google Scholar 9 : Incidence, extent and location of unsuspected pelvic lymph node metastasis in patients undergoing radical cystectomy for bladder cancer. J. Urol.1987; 137: 408. Link, Google Scholar 10 : Technique of radical cystectomy. In: Diagnosis and Management of Genitourinary Cancer. Philadelphia: W.B. Saunders Co.1988: 607. chapt 42. Google Scholar 11 : Radical cystectomy in the male patient. Eur. Video J. Urol.1997; 4. Google Scholar 12 : TNM Classification of Malignant Tumours. Edited by . New York: Springer Verlag1992: 154. Google Scholar 13 : The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. New Engl. J. Med.1985; 312: 1604. Google Scholar 14 : Will Rogers and the results of radical cystectomy for invasive bladder cancer. Urol. Clin. N. Amer.1991; 18: 529. Google Scholar 15 : Mesorectal excision for rectal cancer. Lancet1993; 341: 457. Google Scholar 16 : Local recurrence following total mesorectal excision for rectal cancer. Brit. J. Surg.1996; 83: 375. Google Scholar 17 : Radical cystectomy for high risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction. Cancer1995; 76: 833. Crossref, Medline, Google Scholar 18 : Results of contemporary radical cystectomy for invasive bladder cancer: a clinicopathological study with an emphasis on the inadequacy of the tumor, nodes and metastasis classification. J. Urol.1991; 145: 45. Link, Google Scholar 19 : Radical cystectomy for stage Ta, TiS and T1 transitional cell carcinoma of the bladder. J. Urol.1994; 151: 31. Link, Google Scholar 20 : The risk of radical cystectomy. Brit. J. Urol.1989; 63: 483. Google Scholar 21 : Management of invasive and high-grade bladder cancer. In: Diagnosis and Management of Genitourinary Cancer. Philadelphia: W.B. Saunders Co.1988: 295. chapt 16. Google Scholar 22 : The value of regional lymph node dissection in genitourinary cancer. Sem. Surg. Oncol.1989; 5: 235. Google Scholar From the Departments of Urology and Pathology, Herlev Hospital, University of Copenhagen, Herlev, Denmark© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byRoth B, Zehnder P, Birkhäuser F, Burkhard F, Thalmann G and Studer U (2012) Is Bilateral Extended Pelvic Lymphadenectomy Necessary for Strictly Unilateral Invasive Bladder Cancer?Journal of Urology, VOL. 187, NO. 5, (1577-1582), Online publication date: 1-May-2012.Patel A and Steinberg G (2012) Editorial CommentJournal of Urology, VOL. 187, NO. 4, (1204-1205), Online publication date: 1-Apr-2012.Zehnder P, Studer U, Skinner E, Dorin R, Cai J, Roth B, Miranda G, Birkhäuser F, Stein J, Burkhard F, Daneshmand S, Thalmann G, Gill I and Skinner D (2011) Super Extended Versus Extended Pelvic Lymph Node Dissection in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Comparative StudyJournal of Urology, VOL. 186, NO. 4, (1261-1268), Online publication date: 1-Oct-2011.Dangle P, 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Volume 160Issue 6 Part 1December 1998Page: 2015-2020 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.Metrics Author Information ASGER L. POULSEN More articles by this author THOMAS HORN More articles by this author KENNETH STEVEN More articles by this author Expand All Advertisement PDF downloadLoading ...