Korean J Urol Oncol.  2016 Dec;14(3):124-129. 10.22465/kjuo.2016.14.3.124.

Comparisons between Standard and Extended Pelvic Lymph Node Dissections During Radical Cystectomy in Patients with Bladder Cancer: Emphasis on Staging Ability and Perioperative Complications

• Lee SE
• Lee H
• Sung HH
• Seo SI
• Jeon SS
• Lee HM
• Choi HY
• Jeong BC

• KMID: 2368945
• DOI: http://doi.org/10.22465/kjuo.2016.14.3.124

Abstract

PURPOSE
We compared the staging ability and early complications of standard and extended pelvic lymph node dissection (sPLND and ePLND, respectively) in patients with localized bladder cancer during radical cystectomy.
MATERIALS AND METHODS
We prospectively collected and analyzed the data of 261 patients who underwent radical cystectomy for localized bladder cancer. The resected lymph nodes were categorized according to anatomic locations and were carefully inspected by an experienced pathologist. The perioperative complications were classified using the Clavien-Dindo classification system.
RESULTS
The 2 groups showed no significant differences in preoperative characteristics except for preoperative clinical stage (p=0.015). There were no significant differences in pathologic outcomes including pathologic stage, positive surgical margin, and lymphovascular invasion (all p>0.05), but the sPLND group showed a significantly higher cellular grade (p<0.001). The ePLND group showed a higher number of removed lymph nodes than the sPLND group (p=0.015) and a higher rate of positive lymph node invasion (35.8% vs. 28.9%). There were no significant differences in complication rates according to the extent of lymph dissection and urinary diversion type, respectively (p=0.063 and p=0.486).
CONCLUSIONS
The ePLND showed more accurate nodal staging ability with comparable complication rates when compared to sPLND in patients who underwent radical cystectomy for localized bladder cancer. A further, larger prospective study is needed to confirm the result of the present study.

Keyword

Urinary bladder neoplasms; Radical cystectomy; Lymph node excision

MeSH Terms

Classification
Cystectomy*
Humans
Lymph Node Excision*
Lymph Nodes*
Prospective Studies
Urinary Bladder Neoplasms*
Urinary Bladder*
Urinary Diversion