Balancing risk and benefit of extended pelvic lymph node dissection in patients undergoing radical cystectomy

• Published in: World journal of urology Vol. 34; no. 1; pp. 41 - 48
• Main Authors: Abdi, H., Pourmalek, F., Gleave, M. E., So, A. I., Black, P. C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2016; Springer Nature B.V
• Subjects: Aged; Blood Loss, Surgical; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Case-Control Studies; Cohort Studies; Cystectomy - methods; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Lymph Node Excision - methods; Lymph Nodes - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Nephrology; Oncology; Pelvis; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Survival Rate; Topic Paper; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urology; Bladder neoplasm; Recurrence; Prognosis; Pelvic lymph node dissection; Urothelial carcinoma; Radical cystectomy; Survival
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-015-1734-x

Purpose The optimal extent of pelvic lymph node dissection (PLND) during radical cystectomy (RC) in patients with urothelial carcinoma of the bladder (UCB) is the subject of ongoing debate. In this study, we compared local recurrence-free and overall survival, in addition to complication rates, after extended PLND (ePLND) compared to standard PLND (sPLND). Methods We reviewed the charts of 314 patients who underwent RC for UCB between 2008 and 2013. ePLND was performed in 105 patients, and 105 matched patients who underwent standard PLND (sPLND) were selected based on clinical parameters. Local recurrence-free and overall survival rates were assessed using Kaplan–Meier survival analysis, and Cox proportional hazards models were used to assess potential determinants of these outcomes. Complications were assessed at 30 and 90 days using the Clavien–Dindo reporting system. Results More lymph nodes were removed by ePLND (median 21) compared to sPLND (median 9; P  < 0.001), but the rate of nodal involvement was not different. In multivariable analysis, ePLND was associated with a better local recurrence-free survival (HR = 0.63, P  = 0.005), but was not an independent predictor of overall survival (HR = 1.06, P  = 0.84). Estimated blood loss was greater with ePLND (1047.3 vs. 584.5 ml P  < 0.001), but there was no significant difference in complications. Conclusions Extended PLND appears to reduce the risk of local recurrence, but was not an independent predictor of overall survival in this cohort. ePLND was associated with greater blood loss compared to sPLND, but not with other perioperative complications.