Does skip metastasis or other lymph node parameters have additional effects on survival of patients undergoing radical cystectomy for bladder cancer?

PURPOSE: To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND). MATERIALS AND METHODS: RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis. RESULTS: The mean number of lymph nodes removed per patient was 29.4+/-9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9+/-27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS. CONCLUSIONS: No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients.

Effect of Type 2 Diabetes Mellitus on Prognosis of Nonmetastatic Renal Cell Cancer

PURPOSE: We evaluated the prognostic value of type 2 diabetes mellitus (DM) in patients treated surgically for localized renal cell carcinoma (RCC). MATERIALS AND METHODS: Between 1995 and 2011, 588 patients with renal tumor diagnoses were treated surgically and 492 patients with pathologically confirmed nonmetastatic RCC diagnoses were included in the study. The associations of clinical and pathologic parameters with a type 2 DM diagnosis were evaluated. Kaplan-Meier estimations for disease-specific survival (DSS) and overall survival (OS) were generated according to type 2 DM diagnosis, and the log-rank test was used to compare survival according to the variables. RESULTS: The mean age of the patients was 56.7+/-12 years (range, 15 to 84 years; median, 58 years) and the mean length of follow-up was 35.9+/-28 months (range, 1 to 145 months; median, 34.3 months). Of the 492 patients, 62 (12.6%) had a diagnosis of DM at the time of surgery (group I) and 430 did not have DM (group II). The mean age and the incidence of clear cell RCC histological subtype were significantly higher in group I than in group II (p<0.001 and p=0.036, respectively). Although DSS and OS were lower in group I, this difference was not significant. Type 2 DM was not detected as an independent prognostic factor for DSS and OS. CONCLUSIONS: This study investigated the role and effect of DM on the prognosis of localized RCC that was treated surgically. The present study did not detect DM as an independent prognostic factor for RCC.

Extended Pelvic Lymph Node Dissection: Before or after Radical Cystectomy? A Multicenter Study of the Turkish Society of Urooncology

PURPOSE: We aimed to ascertain the effects of performing extended pelvic lymph node dissection (PLND) on the duration of surgery, morbidity, and the number of lymph nodes removed when the dissection was performed before or after radical cystectomy (RC). MATERIALS AND METHODS: We used the database of our previous prospective multicenter study. A total of 118 patients underwent RC and extended PLND. Of the 118 patients, 48 (40.7%) underwent extended PLND before RC (group 1) and 70 (59.3%) underwent extended PLND after RC (group 2). The two groups were compared for extended PLND time, RC time, and total operation times, per operative morbidity, and the total numbers of lymph nodes removed. RESULTS: Clinical and pathologic characteristics were comparable in the two groups (p>0.05). The mean RC time and mean total operation times were significantly shorter in group 1 than in group 2 (p<0.001). The mean number of lymph nodes removed was 27.31+/-10.36 in group 1 and 30.87+/-8.3 in group 2 (p=0.041). Only at the presacral region was the mean number of lymph nodes removed significantly fewer in group 1 than in group 2 (p=0.001). Intraoperative and postoperative complications and drain withdrawal time were similar in both groups (p=0.058, p=0.391, p=0.613, respectively). CONCLUSIONS: When extended PLND was performed before RC, the duration of RC and consequently the total duration of the operation were significantly shorter than when extended PLND was performed after RC. Practitioners may consider performing extended PLND before RC and rechecking the presacral area for additional lymph nodes after RC, particularly in elderly patients with high co-morbidity for whom the duration of surgery matters.

Extended Pelvic Lymph Node Dissection: Before or after Radical Cystectomy? A Multicenter Study of the Turkish Society of Urooncology

PURPOSE: We aimed to ascertain the effects of performing extended pelvic lymph node dissection (PLND) on the duration of surgery, morbidity, and the number of lymph nodes removed when the dissection was performed before or after radical cystectomy (RC). MATERIALS AND METHODS: We used the database of our previous prospective multicenter study. A total of 118 patients underwent RC and extended PLND. Of the 118 patients, 48 (40.7%) underwent extended PLND before RC (group 1) and 70 (59.3%) underwent extended PLND after RC (group 2). The two groups were compared for extended PLND time, RC time, and total operation times, per operative morbidity, and the total numbers of lymph nodes removed. RESULTS: Clinical and pathologic characteristics were comparable in the two groups (p>0.05). The mean RC time and mean total operation times were significantly shorter in group 1 than in group 2 (p<0.001). The mean number of lymph nodes removed was 27.31+/-10.36 in group 1 and 30.87+/-8.3 in group 2 (p=0.041). Only at the presacral region was the mean number of lymph nodes removed significantly fewer in group 1 than in group 2 (p=0.001). Intraoperative and postoperative complications and drain withdrawal time were similar in both groups (p=0.058, p=0.391, p=0.613, respectively). CONCLUSIONS: When extended PLND was performed before RC, the duration of RC and consequently the total duration of the operation were significantly shorter than when extended PLND was performed after RC. Practitioners may consider performing extended PLND before RC and rechecking the presacral area for additional lymph nodes after RC, particularly in elderly patients with high co-morbidity for whom the duration of surgery matters.