ABSTRACT
To evaluate the role of pelvic lymph node dissection [PLND] during radical cystectomy for bladder cancer as regards to the extent of nodal dissection and the necessary number of lymph nodes to be removed. Retrospective study was done on 198 patients with invasive bladder cancer treated with radical cystectomy and urinary diversion. Regional PLND include internal iliac, external iliac, and obturator nodes. The study evaluates the impact of pelvic lymph node involvement and the number of nodes removed during surgery on survival of patients. Lymph node metastases were detected in 54 patients [27.3%]. The average number of nodes removed in the node-positive and node-negative patients was 13.7 and 14.4 respectively. Although no difference was found in disease-specific survival in the node-negative patients when stratified by the number of nodes removed [13 or more versus less than 13], a significant survival advantage was found in the node-positive patients with 13 or more nodes removed versus less than 13 nodes removed. The patients with four or more positive nodes had a worse outcome than those with less than four positive nodes. However, even if the patients had less than four positive nodes, the survival of patients with less than 13 nodes removed was as poor as that of the patients with four or more positive nodes. In this series, the removal of 13 or more pelvic lymph nodes was essential for more accurate pathologic examination to predict patient outcome and contributed to an increased chance of survival