Lymph node staging in bladder cancer: role of diffusion weighted magnetic resonant imaging compared to histopathology

Background : lymph node metastasis is important prognostic factor in bladder cancer paients.It also helps in treatment planning.Diffusion weighted magnetic resonance imaging is a new technique for lymph node evaluation depending on tissue cellurality rather than size of lymph nodes. Purpose : The aim of this work is to study the role of DW_MRI in detecting LNs metastasis and staging in bladder cancer. Methods: The study has been carried out at the department of Urology, Zagazig University Hospitals from July 2016 till December 2018. Results: 33 patients with radical cystectomy and lymphadenectomy whom were evaluated by DW-MRI preoperatively. The overall senstivity of DW-MRI was 85.7% and overall specificty was 94.7%. Conclusion: DW-MRI is a safe non invasive technique in lymph node staging in bladder cancer patients with high senstivity and specificty

The first series of laparoscopic radical cystectomies done in South Africa

Background: Radical cystectomy (RC) with extended lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive urothelial carcinoma. Laparoscopic radical cystectomies (LRC) have been performed at Groote Schuur Hospital (GSH) since 2009. We aimed to audit our data regarding complications and oncological outcome and compare it to data obtained from patients undergoing open radical cystectomy (ORC) by the same surgeon since 2007.Methods: All adult patients who underwent open and laparoscopic RC from 2007 to 2013 have been included in the study. Data on demographics, operative time, intraoperative blood loss, postoperative complications, margin positivity, and lymph nodes was obtained retrospectively by means of folder review.Results: Thirty (30) patients who underwent LRC and 32 who underwent ORC were included in the study. Participants undergoing ORC experienced shorter operative duration (301 minutes versus 382 minutes; p-value < 0.0001), increased blood loss (1376 ml versus 779ml; p-value = 0.0023) and transfusion requirement (2 units versus 0; p-value = 0.071) in contrast to LRC. Postoperative complications were more prevalent in the ORC arm compared to the LRC arm (61% versus 43%). Patients with a past medical history were at higher risk of experiencing postoperative complications (p-value = 0.04; Risk Ratio: 1.6). Margin positivity was comparable between the two arms. A higher number of nodes was sampled by the laparoscopic technique in this study (overall p-value = 0.07).Conclusion: Laparoscopic RC is associated with longer operative times, decreased blood loss, and equivalent oncological outcomes when compared to ORC. Laparoscopic RC is a feasible option in our setting

Penectomy with Simultaneous Compared to deferred Bilateral Inguinal Lymph Node Dissection for Squamous Cell Carcinoma of the Penis - Evaluation of Surgical Complications

Objective: In men with advanced squamous cell carcinoma of the penis; inguinal lymph node dissection is usually deferred for 6 weeks after primary penectomy. The rationale is that the penile lesion is usually infected and immediate lymphadenectomy may lead to a higher surgical complication rate. However; some patients do not return for deferred node dissection and then present much later with incurable metastatic disease. The aim of this study was to compare the complication rates of simultaneous versus deferred bilateral inguinal lymph node dissection. Patients and Methodsn: From October 1999 to September 2006; 29 men with histologically confirmed squamous cell carcinoma of the penis were treated. Penectomy with simultaneous bilateral inguinal lymph node dissection was performed in 18 patients with locally advanced primary lesions (cT2 in 8; cT3 in 10) and palpable inguinal nodes. The complications were compared with a previous study of 34 men who underwent bilateral inguinal lymph node dissection at a mean of 72 days after penectomy at Tygerberg Hospital during the period November 1983 to April 1995. Results: Post-operative complications occurred in 11 of 18 patients (61.1): lymphocele formation in 8; lymph leak in 1; wound dehiscence and skin edge necrosis in 5; wound sepsis in 1; lymphedema of the legs in 2; scrotal edema in 1 and cellulitis in 2 patients (more than one complication occurred in some patients). In the previously reported comparison group who had undergone deferred inguinal lymph node dissection at a mean of 72 days after penectomy; complications occurred in 26 of 34 (76.5) patients: wound sepsis in 12; wound dehiscence in 7; lymphocele in 7; lymph leak in 4; wound abscess in 3; necrosis of wound edges in 2 and hematoma formation in 1. Conclusion: Penectomy with simultaneous bilateral inguinal lymph node dissection in men with squamous cell carcinoma of the penis does not lead to a higher complication rate compared with primary penectomy and deferred inguinal lymph node dissection performed at a mean of 10 weeks after the primary procedure