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Extended Lymph Node Dissection

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Bladder Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Radical cystectomy with pelvic lymphadenectomy remains the standard therapy for high-grade invasive bladder cancer with well-documented oncological outcomes. Several studies have demonstrated the prognostic and therapeutic benefits of an appropriately performed lymph node dissection. While the need for pelvic lymphadenectomy in the management of bladder cancer is clear, the optimal template or number of lymph nodes that should be removed remains controversial. The historical evolution and current role of an extended pelvic lymphadenectomy in the management of bladder cancer is the focus of this chapter.

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References

  1. 1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ. Cancer Statistics, 2006. CA Cancer J Clin 2006;56:106–130.

    Article  PubMed  Google Scholar 

  2. 2. Konety BR, Joslyn SA, O'Donnell MA. Extent of pelvic lympadenectomy and its impact on outcome in patients diagnosed with bladder cancer: analysis of data from the surveillance, epidemiology, and end results program data base. J Urol 2003;169:946–950.

    Article  PubMed  Google Scholar 

  3. 3. Prout GR, Marshall VF. The prognosis with untreated bladder tumors. Cancer 1956;9:551–558.

    Article  CAS  PubMed  Google Scholar 

  4. 4. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng A, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, Raghavan D, Skinner DG. Radical Cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncology 2001;19:666–675.

    CAS  Google Scholar 

  5. 5. Abol-Enein H, El-Baz M, Abd El-Hameed MA, Abdel-Latif M, Ghoneim MA. Lymph node involvement in patients with bladder cancer treated with radical cystectomy: a patho-anatomical study-a single center experience. J Urol 2004;172:1818–1821.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  8. Roehrborn CG, Sagalowsky AI, Peters PC. Long-term patient survival after cystectomy for regional metastatic transitional cell carcinoma of the bladder. J Urol 1991;146:36–39.

    CAS  PubMed  Google Scholar 

  9. 9. Abdel-Latif M, Abol-Enein H, El-Baz M, Ghoneim MA. Nodal involvement in bladder cancer cases treated with radical cystectomy: incidence and prognosis. J Urol 2004;172:85–89.

    Article  PubMed  Google Scholar 

  10. Vieweg J, Gschwend JE, Herr HW, Fair WR. Pelvic lymph node dissection can be curative in patients with node positive bladder cancer. J Urol 1999;161:449–454.

    Article  CAS  PubMed  Google Scholar 

  11. Mills RD, Turner WH, Fleischmann A, Markwalder R, Thalmann GN, Studer UE. Pelvic lymph node metastases form bladder cancer: outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy. J Urol 2001;166:19–23.

    Article  CAS  PubMed  Google Scholar 

  12. Dretler SP, Ragsdale BD, Leadbetter WF. The value of pelvic lymphadenectomy in the surgical treatment of bladder cancer. J Urol 1973;109:414–416.

    CAS  PubMed  Google Scholar 

  13. Cookson MS, Chang SS, Wells N, Parekh DJ, Smith JA. Complications of radical cystectomy for nonmuscle invasive disease: comparison with muscle invasive disease. J Urol 2003;169:101–104.

    Article  PubMed  Google Scholar 

  14. Poulsen AL, Horn T, Steven K. Radical cystectomy: extending the limits of pelvic lymph node dissection improves survival for patients with bladder cancer confined to the bladder wall. J Urol 1998;160:2015–2020.

    Article  CAS  PubMed  Google Scholar 

  15. Lebret T, Herve J, Yonneau L, Molinie V, Barre P, Lugagne P, Butreau M, Laurent M, Botto H. After cystectomy, is it justified to perform a bladder replacement for patients with lymph node positive bladder cancer. Eur Urol 2002;42:344–349.

    Article  PubMed  Google Scholar 

  16. Allaf ME, Palapattu GS, Trock BJ, Carter HB, Walsh PC. Anatomic extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol 2004;172:1840–1844.

    Article  PubMed  Google Scholar 

  17. Heidenreich A, Varga Z, Von Konbloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 2002;167:1681–1686.

    Article  PubMed  Google Scholar 

  18. Schafhauser W, Ebert A, Brod J, Petsch S, Schrott KM. Lymph node involvement in renal cell carcinoma and survival chance by systematic lymphadencetomy. Anticancer Res 1999;19:1573–1578.

    CAS  PubMed  Google Scholar 

  19. Terrone C, Guercio S, De Luca S, Poggio E, Castelli E, Scoffone C, Tarabuzzi R, Scarpa RM, Fontana D, Rocca Rossetti S. The number of lymph nodes examined and staging accuracy in renal cell carcinoma. BJU Int 2003;91:37–40.

    Article  CAS  PubMed  Google Scholar 

  20. Pantuck AJ, Zisman A, Dorey F, Chao DH, Han K, Said J, Gitlitz BJ, Figlin RA, Belldegrun AS. Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol 2003;169:2076–2083.

    Article  PubMed  Google Scholar 

  21. Barth PJ, Gerharz EW, Ramaswamy A, Reidmiller H. The influence of lymph node counts on the detection of pelvic lymph node metastasis in prostate cancer. Path Res Prac 1999;195:633–636.

    CAS  Google Scholar 

  22. Brössner C, Pycha A, Toth A, Mian C, Kuber W. Does extended lymphadenectomy increase the morbidity of radical cystectomy?. BJU Int 2004;93:64–66.

    Article  PubMed  Google Scholar 

  23. Halsted WS. The treatment of wounds. Johns Hopkins Hosp Rep 1891;2:279.

    Google Scholar 

  24. Taylor GW, Wallace RH. Carcinoma of the breast. End results: Massachusetts general hospital 1933–1935. N Engl J Med 1947;237:475–477.

    Article  CAS  PubMed  Google Scholar 

  25. Leadbetter WF, Cooper JF. Regional gland dissection for carcinoma of the bladder: a technique for one-stage cystectomy, gland dissection, and bilateral uretero-enterostomy. J Urol 1950;63:242–226.

    CAS  PubMed  Google Scholar 

  26. Kerr WS, Colby FH. Pelvic lymphadenectomy and total cystectomy in the treatment of carcinoma of the bladder. J Urol 1950;63:842–851.

    Google Scholar 

  27. Colston JA, Leadbetter WF. Infiltrating carcinoma of the bladder. J Urol 1936;36:669–689.

    Google Scholar 

  28. Whitmore WF, Marshall VF. Radical total cystectomy for cancer of the bladder: 230 consecutive cases five years later. J Urol 1962;87:853–868.

    PubMed  Google Scholar 

  29. Dretler SP, Ragsdale BD, Leadbetter WF. The value of pelvic lymphadenectomy in the surgical treatment of bladder cancer. J Urol 1973;109:414–416.

    CAS  PubMed  Google Scholar 

  30. Skinner DG. Management of invasive bladder cancer: a meticulous pelvic lymph node dissection can make a difference. J Urol 1982;128:34–36.

    CAS  PubMed  Google Scholar 

  31. Smith JA, Whitmore WF. Regional lymph node metastasis from bladder cancer. J Urol 1981;126:591–593.

    PubMed  Google Scholar 

  32. Leissner J, Ghoneim MA, Abol-Enein H, Thuroff JW, Franzaring L, Fisch M, Schulze H, Managadze G, Allhaoff EP, El-Baz MA, Kastendieck H, Buhtz P, Kropf A, Hohenfellner R, Wolf HK. Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. J Urol 2004;171:139–144.

    Article  CAS  PubMed  Google Scholar 

  33. Wishnow KI, Johnson DE, Ro JY, Swanson DA, Babian RJ, von Eschenbach AC. Incidence, extent and location of unsuspected pelvic lymph node metastasis in patient undergoing radical cystectomy for bladder cancer. J Urol 1987;137:408–410.

    CAS  PubMed  Google Scholar 

  34. Bochner BH, Cho D, Herr HW, Donat M, Kattan MW, Dalbagni G. Prospectively packaged lymph node dissections with radical cystectomy: evaluation of node count variability and node mapping. J Urol 2004;172:1286–1290.

    Article  PubMed  Google Scholar 

  35. Cochran AJ, Roberts AA, Saida T. The place of lymphatic mapping and sentinel node biopsy in oncology. Int J Clin Oncol 2003;8:139–150.

    Article  PubMed  Google Scholar 

  36. Vazina A, Dugi D, Shariat SF, Evans J, Link R, Lerner SP. Stage specific lymph node metastasis mapping in radical cystectomy specimens. J Urol 2004;171:1830–1834.

    Article  PubMed  Google Scholar 

  37. Cunningham JH. Tumors of the Bladder. J Urol 1931;25:559–587.

    Google Scholar 

  38. Jewett HJ, Strong GH. Infiltrating carcinoma of the bladder: relation of depth of penetration of the bladder wall to incidence of local extension and metastases. J Urol 1946;55:366–372.

    CAS  PubMed  Google Scholar 

  39. Herr H, Lee C, Chang S, Lerner S. for the bladder cancer collaborative group. Standardization of radical cystectomy and pelvic lymph node dissection for bladder cancer: a collaborative group report. J Urol 2004;171:1823–1828.

    Article  PubMed  Google Scholar 

  40. Bochner BH, Herr HW, Reuter VE. Impact of separate versus en bloc pelvic lymph node dissection on the number of lymph nodes retrieved in cystecomy specimens. J Urol 2001;166:2295–2296.

    Article  CAS  PubMed  Google Scholar 

  41. Quek ML, Sanderson KM, Daneshmand S, Stein JP. The importance of an extended lymphadenectomy in the management of high-grade invasive bladder cancer. Expert Rev Anticancer Ther 2004;4:1007–1016.

    Article  PubMed  Google Scholar 

  42. Skinner DG. Technique of radical cystectomy. Urol Clin N Am 1981;3:353–366.

    Google Scholar 

  43. Finelli A, Gill IS, Desai MM, Moinzadeh A, Magi-Galluzzi C, Kaouk JH. Laparoscopic extended pelvic lymphadenectomy for bladder cancer: technique and initial outcomes. J Urol 2004;172:1809–1812.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  45. Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP, Raghaven D, Crawford ED. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003;349:859–866.

    Article  CAS  PubMed  Google Scholar 

  46. Herr HW. Surgical factors in bladder cancer: more (nodes) + more (pathology) = less (mortality). BJU Int 2003;92:187–188.

    Article  CAS  PubMed  Google Scholar 

  47. Quek ML, Stein JP, Daneshmand S, Miranda G, Thangathurai D, Roffey P, Skinner EC, Lieskovsky G, Skinner DG. A critical analysis of perioperative mortality from radical cystectomy. J Urol 2006;175:886–890.

    Article  PubMed  Google Scholar 

  48. Chang SS, Cookson MS, Baumgartner RG, Wells N, Smith JA. Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol 2002;167:2012–2016.

    Article  PubMed  Google Scholar 

  49. Ghoneim MA, El-Mekresh MM, El-Baz MA, El-Attar IA, Ashamallah A. Radical cystectomy for carcinoma of the bladder: critical evaluation of the results of 1,026 cases. J Urol 1997;158:393–399.

    Article  CAS  PubMed  Google Scholar 

  50. Rosario DJ, Becker M, Anderson JB. The changing pattern of mortality and morbidity from radical cystectomy. BJU Int 2000;85:427–430.

    Article  CAS  PubMed  Google Scholar 

  51. Frazier HA, Robertson JE, Paulson DF. Complications of radical cystectomy and urinary diversion: a retrospective review of 675 cases in 2 decades. J Urol 1992;148:1401–1405.

    CAS  PubMed  Google Scholar 

  52. Herr HW, Donat M. Outcome of patients with grossly node positive bladder cancer after pelvis lymph node dissection and radical cystectomy. J Urol 2001;165:62–64.

    Article  CAS  PubMed  Google Scholar 

  53. Herr HW, Faulkner JR, Grossman B, Natale RB, deVere White R, Sarosdy MF, Crawford ED. Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncology 2004;22:2781–2789.

    Article  Google Scholar 

  54. Herr HW. Superiority of ratio based lymph node staging for bladder cancer. J Urol 2003;169:943–945.

    Article  PubMed  Google Scholar 

  55. Fleischmann A, Thalmann GN, Markwalder R, Studer UE. Extracapsular extension of pelvic lymph node metastases from urothelial carcinoma of the bladder is an independent prognostic factor. J Clin Oncology 2005;23: 2358–2365.

    Article  Google Scholar 

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Correspondence to Marcus L. Quek .

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© 2009 Humana Press, a part of Springer Science+Business Media, LLC

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Woods, M.E., Quek, M.L. (2009). Extended Lymph Node Dissection. In: Lee, C., Wood, D. (eds) Bladder Cancer. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-59745-417-9_14

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  • DOI: https://doi.org/10.1007/978-1-59745-417-9_14

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