Clinico-pathological study of pelvic lymph node dissection in radical cystectomy for the treatment of bladder cancer [T2-T4]

ABSTRACT

Pelvic lymph node status considered the most significant factor for invasive bladder cancer [Il-TV] outcome and treatment decision are based on the presence or absence of nodal disease. To evaluate the role of pelvic lymph node dissection [PLND] during radical cystectorny with urinary diversion for bladder cancer as regards to the extent of nodal dissection and the necessary number of lymph nodes to be removed. This prospective study has been completed on 50 patients with invasive bladder cancer [T2-T4] and radical cystectorny with urinary diversion and pelvic lymph node dissection was done at the Surgical Oncology Unit, Al-Azhar University from February 2000 to February 2006. Their age ranged from 38 to 67 with an average of6l years, 40 males and 10 females. Regional pelvic lymph node dissection includes 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 15 patients [30%]. 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 the 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