J Leissner1. 1. Klinik und Poliklinik für Urologie, Universitätsklinikum, Bonn. leissner@uni-bonn.de
Abstract
BACKGROUND: Pelvic lymphadenectomy for invasive bladder cancer is not a standardized procedure and its relevance for staging and prognoses is still under discussion. A number of retrospective studies have demonstrated a positive correlation between extent of lymphadenectomy and prognosis after radical cystectomy. MATERIALS AND METHODS: In a retrospective study, we correlated the extent of lymphadenectomy with survival after radical cystectomy. Thereafter, we conducted a prospective study to investigate the limits of pelvic lymphadenectomy and the pattern of lymphatic spread. RESULTS: Retrospectively, we found a significantly better survival for patients when 15 and more lymph nodes were removed. The individual surgeon was also evaluated as an important prognostic factor. CONCLUSIONS: Based on retrospective data, an extended and complete pelvic lymphadenectomy improves the prognosis. The cranial border should be at least at the level of the aortic bifurcation. A prospective randomized study will have to clarify the effect of lymphadenectomy on the prognosis of patients after radical cystectomy.
BACKGROUND: Pelvic lymphadenectomy for invasive bladder cancer is not a standardized procedure and its relevance for staging and prognoses is still under discussion. A number of retrospective studies have demonstrated a positive correlation between extent of lymphadenectomy and prognosis after radical cystectomy. MATERIALS AND METHODS: In a retrospective study, we correlated the extent of lymphadenectomy with survival after radical cystectomy. Thereafter, we conducted a prospective study to investigate the limits of pelvic lymphadenectomy and the pattern of lymphatic spread. RESULTS: Retrospectively, we found a significantly better survival for patients when 15 and more lymph nodes were removed. The individual surgeon was also evaluated as an important prognostic factor. CONCLUSIONS: Based on retrospective data, an extended and complete pelvic lymphadenectomy improves the prognosis. The cranial border should be at least at the level of the aortic bifurcation. A prospective randomized study will have to clarify the effect of lymphadenectomy on the prognosis of patients after radical cystectomy.
Authors: J J Bonenkamp; J Hermans; M Sasako; C J van de Velde; K Welvaart; I Songun; S Meyer; J T Plukker; P Van Elk; H Obertop; D J Gouma; J J van Lanschot; C W Taat; P W de Graaf; M F von Meyenfeldt; H Tilanus Journal: N Engl J Med Date: 1999-03-25 Impact factor: 91.245
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