Role and extent of lymphadenectomy during radical cystectomy for invasive bladder cancer

Svatek, Robert; Zehnder, Pascal (2012). Role and extent of lymphadenectomy during radical cystectomy for invasive bladder cancer. Current urology reports, 13(2), pp. 115-21. Philadelphia, Pa.: Current Science

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There is substantial variability in the extent of the node dissection performed during radical cystectomy for bladder cancer. Here, we review the diagnostic assessment of lymph node metastasis and the prognostic and therapeutic benefit for pelvic node dissection for bladder cancer. A review of the applicable urologic literature regarding the topics of lymphadenectomy for bladder cancer was conducted. Nodal metastasis above a limited or standard template is not uncommon, with up to 16% of all nodal metastasis detected proximal to the aortic bifurcation. However, skip metastasis is extremely rare. Proteins associated purely with epithelial tissue such as cytokeratin (CK)-19, CK-20, and uroplakin II have been observed in reportedly negative nodal specimens, which indicates that routine microscopic analysis of nodal tissue may miss small foci of metastatic cancer. In addition to the surgical technique, the total number of lymph nodes removed is influenced by patient anatomy and pathologic processing and therefore may be unsuitable as a procedural quality statement. Consecutively, meticulous removal of tissue within a defined and uniformly applied template may be more relevant than absolute nodal count. Observational cohort series indicate an improved oncologic outcome for patients undergoing extensive nodal dissection. The results of two randomized controlled trials addressing the extent of nodal dissection for bladder cancer are forthcoming.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology
UniBE Contributor:	Zehnder, Pascal Claude
ISSN:	1527-2737
Publisher:	Current Science
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:38
Last Modified:	05 Dec 2022 14:12
PubMed ID:	22328190
URI:	https://boris.unibe.ch/id/eprint/15448 (FactScience: 222795)