Improving the prognosis of patients after radical cystectomy. Part I: the role of lymph node dissection.

The first two reviews are from the same unit in Germany and describe the well-known but still much discussed ways of improving the prognosis of patients undergoing cystectomy for bladder cancer. The authors review the roles of lymph node dissection and perioperative chemotherapy, and draw conclusions which will be of help for patients having this form of therapy. In a further review, authors from Egypt debate the requirement for a refluxing or non-refluxing uretero-ileal anastomosis in low-pressure reservoirs, drawing on their extensive experience in this field. The optimum treatment for patients with muscle-invasive bladder cancer remains a matter of intense debate; some authors still question the role of radical cystectomy (RC) per se, as it can be a potentially mutilating procedure with subsequent impairment in quality of life. However, the impairment has not been investigated using validated quality-of-life studies. By contrast, it is commonly accepted that no alternative treatment yields similar long-term survival data to RC. However, survival rates after RC are far from satisfying, particularly for patients with >/= pT3 and/or pN+ disease. Therefore, various strategies were introduced to improve survival in these patients, i.e. extension of lymph node dissection during radical surgery and perioperative chemotherapy. Both strategies are analysed and discussed in two mini-reviews, based on data from current publications and from theoretical considerations.