Philipp Mandel1, Derya Tilki2, Guy D Eslick3. 1. Division of Visceral and Transplant Surgery, University Hospital of Zurich, Switzerland. 2. Department of Urology, University of California, Davis, Medical Center, Sacramento, CA. Electronic address: derya.tilki@ucdmc.ucdavis.edu. 3. The Whiteley-Martin Research Centre, Department of Surgery, The University of Sydney, Sydney, Australia.
Abstract
INTRODUCTION: Lymph node dissection (LND) at the time of radical cystectomy (RC) is the standard of care in the treatment of muscle-invasive bladder cancer. However, no final consensus about its optimal extent has been reached. METHODS: We conducted a meta-analysis to determine the effect of the extent of LND on 5-year recurrence-free survival and its complication rates in patients undergoing RC. A systematic search of MEDLINE, PubMed, and EMBASE has been performed. All studies published until June 2013 and providing information on 5-year recurrence-free survival were included in the analysis. RESULTS: We analyzed the recurrence-free survival data of 11 studies on standard or extended LND or both in patients undergoing RC. The extended (above the bifurcation of iliac vessels) LND showed a significant trend toward a higher proportion of lymph node-positive patients (odds ratio = 1.39; 95% CI: 0.96-2.00; P = 0.08). Including all studies that compare extended with standard LND, the overall odds ratio for the 5-year recurrence-free survival is 1.63 (95% CI: 1.28-2.07, P<0.001), showing a strong and statistical significant survival benefit for the group of patients who underwent extended LND. Moreover, the weighted average 5-year recurrence-free survival rate of all existing studies on standard LND is significantly different from the ones reporting extended LND rates. No differences in perioperative mortality or complication rates were reported. CONCLUSION: The present meta-analysis provides evidence to the positive effect of extended LND on recurrence-free survival and its diagnostic benefit in patients undergoing RC. Patients who underwent extended LND did not suffer from higher complication rates or perioperative mortality.
INTRODUCTION: Lymph node dissection (LND) at the time of radical cystectomy (RC) is the standard of care in the treatment of muscle-invasive bladder cancer. However, no final consensus about its optimal extent has been reached. METHODS: We conducted a meta-analysis to determine the effect of the extent of LND on 5-year recurrence-free survival and its complication rates in patients undergoing RC. A systematic search of MEDLINE, PubMed, and EMBASE has been performed. All studies published until June 2013 and providing information on 5-year recurrence-free survival were included in the analysis. RESULTS: We analyzed the recurrence-free survival data of 11 studies on standard or extended LND or both in patients undergoing RC. The extended (above the bifurcation of iliac vessels) LND showed a significant trend toward a higher proportion of lymph node-positive patients (odds ratio = 1.39; 95% CI: 0.96-2.00; P = 0.08). Including all studies that compare extended with standard LND, the overall odds ratio for the 5-year recurrence-free survival is 1.63 (95% CI: 1.28-2.07, P<0.001), showing a strong and statistical significant survival benefit for the group of patients who underwent extended LND. Moreover, the weighted average 5-year recurrence-free survival rate of all existing studies on standard LND is significantly different from the ones reporting extended LND rates. No differences in perioperative mortality or complication rates were reported. CONCLUSION: The present meta-analysis provides evidence to the positive effect of extended LND on recurrence-free survival and its diagnostic benefit in patients undergoing RC. Patients who underwent extended LND did not suffer from higher complication rates or perioperative mortality.
Authors: Sebastian Piotrowicz; Sławomir Poletajew; Stefan W Czarniecki; Filip Kowalski; Grzegorz Nowak; Maciej Oszczudłowski; Marta Sochaj; Jakub Dobruch; Piotr Radziszewski Journal: Cent European J Urol Date: 2016-10-19
Authors: Angelo Porreca; Luca Di Gianfrancesco; Walter Artibani; Gian Maria Busetto; Giuseppe Carrieri; Alessandro Antonelli; Lorenzo Bianchi; Eugenio Brunocilla; Aldo Massimo Bocciardi; Marco Carini; Antonio Celia; Giovanni Cochetti; Andrea Gallina; Ettore Mearini; Andrea Minervini; Riccardo Schiavina; Sergio Serni; Daniele D'Agostino; Erica Debbi; Paolo Corsi; Alessandro Crestani Journal: Cent European J Urol Date: 2022-05-04
Authors: Antonio Cusano; Peter Haddock; Max Jackson; Ilene Staff; Joseph Wagner; Anoop Meraney Journal: Int Braz J Urol Date: 2016 Jul-Aug Impact factor: 1.541