Skip to main content

Advertisement

SpringerLink
Log in

Lymph node dissection in bladder cancer: Where do we stand?

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Radical cystectomy with lymphadenectomy remains the standard-of-care treatment for muscle-invasive bladder cancer. Lymphadenectomy is a central component of the operation because it continues to play both diagnostic and therapeutic roles. Routinely available preoperative imaging has limited diagnostic accuracy as it relies mostly on size to identify nodal metastasis increasing the value of lymphadenectomy. While the merits of lymphadenectomy are not in question, the extent of lymphadenectomy required to provide maximum benefit while limiting morbidity remains controversial. Furthermore, although robotic-assisted surgery has gained popularity in many centers, concern remains regarding the learning curve required and skill needed to replicate the quality of an open lymphadenectomy. Research efforts have been focused on these unresolved issues, and several trials are currently ongoing to help address these knowledge deficit areas. In this update, we will focus on the current state of lymphadenectomy for bladder cancer and highlight recent advances.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Zehnder P, Studer UE, Skinner EC, Thalmann GN, Miranda G, Roth B et al (2013) Unaltered oncological outcomes of radical cystectomy with extended lymphadenectomy over three decades. BJU Int 112(2):E51–E58

    Article  PubMed  Google Scholar 

  2. Stein JP, Quek ML, Skinner DG (2006) Lymphadenectomy for invasive bladder cancer: I. historical perspective and contemporary rationale. BJU Int 97(2):227–231

    Article  PubMed  Google Scholar 

  3. Kerr WS, Colby FH (1950) Pelvic lymphadenectomy and total cystectomy in the treatment of carcinoma of the bladder. J Urol 63:842

    Google Scholar 

  4. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19(3):666–675

    Article  CAS  PubMed  Google Scholar 

  5. Zehnder P, Studer UE, Daneshmand S, Birkhauser FD, Skinner EC, Roth B et al (2014) Outcomes of radical cystectomy with extended lymphadenectomy alone in patients with lymph node-positive bladder cancer who are unfit for or who decline adjuvant chemotherapy. BJU Int 113(4):554–560

    Article  PubMed  Google Scholar 

  6. Hedgepeth RC, Zhang Y, Skolarus TA, Hollenbeck BK (2011) Variation in use of lymph node dissection during radical cystectomy for bladder cancer. Urology 77(2):385–390

    Article  PubMed  Google Scholar 

  7. Mata DA, Groshen S, Von Rundstedt FC, Skinner DG, Stadler WM, Cote RJ et al (2015) Variability in surgical quality in a phase III clinical trial of radical cystectomy in patients with organ-confined, node-negative urothelial carcinoma of the bladder. J Surg Oncol 111(7):923–928

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cole AP, Dalela D, Hanske J, Mullane SA, Choueiri TK, Meyer CP et al (2015) Temporal trends in receipt of adequate lymphadenectomy in bladder cancer 1988 to 2010. Urol Oncol 33:504

    Article  PubMed  Google Scholar 

  9. Dhar NB, Klein EA, Reuther AM, Thalmann GN, Madersbacher S, Studer UE (2008) Outcome after radical cystectomy with limited or extended pelvic lymph node dissection. J Urol 179(3):873–878 (discussion 878)

    Article  PubMed  Google Scholar 

  10. Zehnder P, Studer UE, Skinner EC, Dorin RP, Cai J, Roth B et al (2011) Super extended versus extended pelvic lymph node dissection in patients undergoing radical cystectomy for bladder cancer: a comparative study. J Urol 186(4):1261–1268

    Article  PubMed  Google Scholar 

  11. Bruins HM, Veskimae E, Hernandez V, Imamura M, Neuberger MM, Dahm P et al (2014) The impact of the extent of lymphadenectomy on oncologic outcomes in patients undergoing radical cystectomy for bladder cancer: a systematic review. Eur Urol 66(6):1065–1077

    Article  PubMed  Google Scholar 

  12. Herr HW, Faulkner JR, Grossman HB, Natale RB, deVere White R, Sarosdy MF et al (2004) Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol 22(14):2781–2789

    Article  PubMed  Google Scholar 

  13. Leissner J, Ghoneim MA, Abol-Enein H, Thuroff JW, Franzaring L, Fisch M et al (2004) Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. J Urol 171(1):139–144

    Article  CAS  PubMed  Google Scholar 

  14. Dangle PP, Gong MC, Bahnson RR, Pohar KS (2010) How do commonly performed lymphadenectomy templates influence bladder cancer nodal stage? J Urol 183(2):499–503

    Article  PubMed  Google Scholar 

  15. Simone G, Papalia R, Ferriero M, Guaglianone S, Castelli E, Collura D et al (2013) Stage-specific impact of extended versus standard pelvic lymph node dissection in radical cystectomy. Int J Urol 20(4):390–397

    Article  PubMed  Google Scholar 

  16. Shariat SF, Ehdaie B, Rink M, Cha EK, Svatek RS, Chromecki TF et al (2012) Clinical nodal staging scores for bladder cancer: a proposal for preoperative risk assessment. Eur Urol 61(2):237–242

    Article  PubMed  Google Scholar 

  17. Bruins HM, Skinner EC, Dorin RP, Ahmadi H, Djaladat H, Miranda G et al (2014) Incidence and location of lymph node metastases in patients undergoing radical cystectomy for clinical non-muscle invasive bladder cancer: results from a prospective lymph node mapping study. Urol Oncol 32(1):24.e13–24.e19

    Article  Google Scholar 

  18. Herr HW, Bochner BH, Dalbagni G, Donat SM, Reuter VE, Bajorin DF (2002) Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer. J Urol 167(3):1295–1298

    Article  PubMed  Google Scholar 

  19. Leissner J, Hohenfellner R, Thuroff JW, Wolf HK (2000) Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis. BJU Int 85(7):817–823

    Article  CAS  PubMed  Google Scholar 

  20. Rink M, Shariat SF, Xylinas E, Fitzgerald JP, Hansen J, Green DA et al (2012) Does increasing the nodal yield improve outcomes in patients without nodal metastasis at radical cystectomy? World J Urol 30(6):807–814

    Article  PubMed  Google Scholar 

  21. Zehnder P, Moltzahn F, Mitra AP, Cai J, Miranda G, Skinner EC et al (2014) Radical cystectomy with super-extended lymphadenectomy: impact of separate vs en bloc lymph node submission on analysis and outcomes. BJU Int. doi:10.1111/bju.12956

    Google Scholar 

  22. Dorin RP, Daneshmand S, Eisenberg MS, Chandrasoma S, Cai J, Miranda G et al (2011) Lymph node dissection technique is more important than lymph node count in identifying nodal metastases in radical cystectomy patients: a comparative mapping study. Eur Urol 60(5):946–952

    Article  PubMed  Google Scholar 

  23. Stein JP, Cai J, Groshen S, Skinner DG (2003) Risk factors for patients with pelvic lymph node metastases following radical cystectomy with en bloc pelvic lymphadenectomy: concept of lymph node density. J Urol 170(1):35–41

    Article  PubMed  Google Scholar 

  24. Karl A, Carroll PR, Gschwend JE, Knuchel R, Montorsi F, Stief CG et al (2009) The impact of lymphadenectomy and lymph node metastasis on the outcomes of radical cystectomy for bladder cancer. Eur Urol 55(4):826–835

    Article  PubMed  Google Scholar 

  25. Yuh BE, Nazmy M, Ruel NH, Jankowski JT, Menchaca AR, Torrey RR et al (2012) Standardized analysis of frequency and severity of complications after robot-assisted radical cystectomy. Eur Urol 62(5):806–813

    Article  PubMed  Google Scholar 

  26. Mmeje CO, Nunez-Nateras R, Nielsen ME, Pruthi RS, Smith A, Wallen EM et al (2013) Oncologic outcomes for lymph node-positive urothelial carcinoma patients treated with robot assisted radical cystectomy: with mean follow-up of 3.5 years. Urol Oncol 31(8):1621–1627

    Article  PubMed  Google Scholar 

  27. Davis JW, Gaston K, Anderson R, Dinney CP, Grossman HB, Munsell MF et al (2011) Robot assisted extended pelvic lymphadenectomy at radical cystectomy: lymph node yield compared with second look open dissection. J Urol 185(1):79–83

    Article  PubMed  Google Scholar 

  28. Raza SJ, Wilson T, Peabody JO, Wiklund P, Scherr DS, Al-Daghmin A et al (2015) Long-term oncologic outcomes following robot-assisted radical cystectomy: results from the international robotic cystectomy consortium. Eur Urol 68(4):721–8

    Article  PubMed  Google Scholar 

  29. Vargas HA, Akin O, Schoder H, Olgac S, Dalbagni G, Hricak H et al (2012) Prospective evaluation of MRI, (1)(1)C-acetate PET/CT and contrast-enhanced CT for staging of bladder cancer. Eur J Radiol 81(12):4131–4137

    Article  CAS  PubMed  Google Scholar 

  30. Birkhauser FD, Studer UE, Froehlich JM, Triantafyllou M, Bains LJ, Petralia G et al (2013) Combined ultrasmall superparamagnetic particles of iron oxide-enhanced and diffusion-weighted magnetic resonance imaging facilitates detection of metastases in normal-sized pelvic lymph nodes of patients with bladder and prostate cancer. Eur Urol 64(6):953–960

    Article  PubMed  Google Scholar 

  31. Kibel AS, Dehdashti F, Katz MD, Klim AP, Grubb RL, Humphrey PA et al (2009) Prospective study of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol 27(26):4314–4320

    Article  PubMed  PubMed Central  Google Scholar 

  32. Goodfellow H, Viney Z, Hughes P, Rankin S, Rottenberg G, Hughes S et al (2014) Role of fluorodeoxyglucose positron emission tomography (FDG PET)-computed tomography (CT) in the staging of bladder cancer. BJU Int 114(3):389–395

    CAS  PubMed  Google Scholar 

  33. Picchio M, Treiber U, Beer AJ, Metz S, Bossner P, van Randenborgh H et al (2006) Value of 11C-choline PET and contrast-enhanced CT for staging of bladder cancer: correlation with histopathologic findings. J Nucl Med 47(6):938–944

    CAS  PubMed  Google Scholar 

  34. Tilki D, Brausi M, Colombo R, Evans CP, Fradet Y, Fritsche HM et al (2013) Lymphadenectomy for bladder cancer at the time of radical cystectomy. Eur Urol 64(2):266–276

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Author contributions

CM Hugen involved in protocol/project development, data collection, and data analysis, wrote, and edited the manuscript. S Daneshmand involved in protocol/project development, data collection, and data analysis, wrote, and edited the manuscript.

Author information

Authors and Affiliations

  1. Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, 1441 Eastlake Ave Suite 7416, Los Angeles, CA, 90033, USA

    Cory M. Hugen & Siamak Daneshmand

Authors
  1. Cory M. Hugen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Siamak Daneshmand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Siamak Daneshmand.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

For this type of study, formal consent is not required.

Statement on the welfare of animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hugen, C.M., Daneshmand, S. Lymph node dissection in bladder cancer: Where do we stand?. World J Urol 35, 527–533 (2017). https://doi.org/10.1007/s00345-015-1751-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-015-1751-9

Keywords

Search

Navigation