Importance and extent of lymph node dissection in the treatment of patients with bladder cancer
https://doi.org/10.17650/1726-9776-2008-4-4-65-70
Abstract
Purpose: The benefit of pelvic lymph node dissection in patients with bladder cancer remains controversial. We have compared these methods of dissection in regard to the following parameters: number of extracted lymph nodes, frequency and location of identifiable metastases, complications rate, and time before development of relapses. Also we have estimated influence of clinical and intra-operative regional changes on a choice of a extent of lymph node dissection.
Materials and methods: Analysis included data on 59 patients who underwent radical cystectomy for bladder cancer between 2002 and 2008. Extended lymph node dissection was carried out in 18 patients (30,5%), and limited lymph node dissection — in 41 (69,5 %) patients.
Results: The average quantity of removed lymph nodes was 11,2 in cases of limited and 20,8 — in cases of extended lymph node dissection. Consequently, the number of revealed metastases has increased from 21,9 to 33,3%. Complex estimation of preoperative and intraoperative data has demonstrated the greatest efficiency in diagnostics of changes in lymph nodes. Among perioperative complications only frequency of lymphorrhea has appeared to be higher in patients after extended lymph node dissection. Disease-free survival rate was 9,8 months (9,4 in cases of limited and 10,1 — in cases of extended dissection).
Conclusions: Extended pelvic lymph node dissection should be recommended as a component of radical cystectomy with diagnostic and, probably, with the therapeutic purpose, especially in patients with suspicion for lymph nodes involvement arisen pre- and/or intra-operatively. Both clinical examination and intra-operative and qualitative pathomorphologic evaluation of regional lymph nodes are very important for full value staging of bladder cancer.
About the Authors
S. B. Petrov
S.M. Kirov Military Medical Academy
Russian Federation
Russian Federation
V. D. Korol
S.M. Kirov Military Medical Academy
Russian Federation
Russian Federation
S. A. Reva
S.M. Kirov Military Medical Academy
Russian Federation
Russian Federation
M. V. Kirichenko
Prof. N.N. Petrov Research Institute of Oncology
Russian Federation
St. Petersburg
Russian Federation
St. Petersburg
References
1. Матвеев Б.П. Статистика онкоурологических заболеваний. Материалы V Всероссийской научно-практической конференции с международным участием. Актуальные вопросы лечения онкоурологических заболеваний. Обнинск, 2003. с. 98.
2. Матвеев Б.П., Фигурин К.М., Карякин О.Б. Рак мочевого пузыря. М., 2001. с. 125—39.
3. Hautmann R.E., Stein G.P. Neobladder with prostatic capsule and seminal-sparing cystectomy for bladder cancer: A step in the wrong direction. Urol Clin North Am 2005;32 (2):177—85.
4. Solsona E., Iborra I., Dumont R. et al. Risk groups in patients with bladder cancer treated with radical cystectomy: statistical and clinical model improving homogeneity. J Urol 2005;174:1226—30.
5. Ghoneim M.A., El-Mekres M.M., El-Baz M.A. et al. Radical cystectomy for carcinoma of the bladder: critical evaluation of the results in 1,026 cases. J Urol 1997;158:393—9.
6. Stein J. P., Cai J., Groshen S. et al. 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.
7. Переверзев А.С., Петров С.Б. Опухоли мочевого пузыря. Харьков, 2002. 301 с.
8. Leissner J., Ghoneim M.A., Abol-Enein H. et al. Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. J Urol 2004;171:139—44.
9. Коган М.И., Перепечай В.А. Современная диагностика и хирургия рака мочевого пузыря. Ростов н/Д, 2002. 240 с.
10. Konety B.R., Joslyn S.A., O'Donnell M.A. Extent of pelvic lymphadenectomy 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 2005;169:946—9.
11. Paik M.L., Scolieri M.J., Brown S.L. et al. Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy. J Urol 2000;163:1693—6.
12. Barentsz J.O., Witjes J.A. Staging urinary bladder cancer after transurethral biopsy. Radiology 1996;201:185—93.
13. Herr H.W. Superiority of ratio based lymph node staging for bladder cancer. J Urol 2003;169:943—5.
14. Solsona E., Iborra I., Dumont R. et al. Risk group in patients with bladder cancer treated with radical cystectomy: statistical and clinical model improving homogeneity. J Urol 2005;174:1226—30.
15. Abol-Enein H., El-Baz M., Abd El-Hameed M.A. et al. Lymph node involvement in patients with bladder cancer treated with radical cystectomy: a pathoanatomical study — a single center experience. J Urol 2004;172:1818—26.
16. Poulsen A.L., 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—20.
17. Leissner J., Ghoneim M.A., Abol-Enein H. et al. Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. J Urol 2004;171:139—44.
18. Skinner D.G., Lieskovsky G. Management of invasive and high-grade bladder cancer. In: Diagnosis and management of genitourinary cancer. Philadelphia; 1988. p. 295—312.
19. Madersbacher S., Hochreiter W., Burkhard F.H. et al. Radical cystectomy for bladder cancer today — a homogeneous series without neoadjuvant therapy. J Clin Oncol 2003;21:690—6.
20. Liedberg F., Mansson W. Lymph node metastasis in bladder cancer. Eur Urol 2006;49:13—21.
21. Stein J.P., Quek M.L., Skinner D.G. Lymphadenectomy for invasive bladder cancer: II. Technical aspects and prognostic factors. BJU Int 2006;97:227—31.
22. Mills R.D., Fleishmann A., Studer U. Lymphadenectomy: how extensive for bladder cancer? Contemp Urol 2005;11:34—41.
23. Хабалов Р.В., Матвеев Б.П., Волкова М.И. и др. Лечение и прогноз больных переходноклеточным раком мочевого пузыря с метастазами в регионарные лимфоузлы. Онкоурология 2007;(4):30—5.
24. Прокоп М., Галански М. Спиральная и многослойная компьютерная томография: учебн. пос. М.; 2006. c. 489—96.
25. ESMO Minimum Clinical Recommendations For diagnosis, treatment and follow-up of invasive bladder cancer. Ann Oncol 2003;14:1008-9.
26. Красный С.А., Суконко О.Г., Ролевич А.И. Результаты лечения больных раком мочевого пузыря с метастазами в регионарных лимфоузлах. Онкоурология 2007;(3):35—41.
Review
For citations:
Petrov S.B., Korol V.D., Reva S.A., Kirichenko M.V. Importance and extent of lymph node dissection in the treatment of patients with bladder cancer. Cancer Urology. 2008;4(4):65-70. (In Russ.) https://doi.org/10.17650/1726-9776-2008-4-4-65-70
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