Lymphadenectomy In Conjunction With Radical Cystectomy

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 26 Sep 2008 - 2:00 PDT

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BERLIN, GERMANY (UroToday.com) - Harry W. Herr, MD and Attending Surgeon, Memorial Sloan-Kettering Cancer Center in New York, discussed the value of lymph node dissection in conjunction with radical cystectomy in the treatment of muscle invasive bladder cancer.

Dr. Herr indicated that a limited lymph node dissection, which is bounded by the external iliac artery, the bifurcation of the iliac vessels, the obturator fossa below the obturator nerve, and the bony pelvic floor, yields a median 12 nodes per patient with a range of 2-31. A standard lymph node dissection extends to the mid portion of the common iliac vessels and then extends dorsally beyond the obturator fossa to the internal iliac vein. It yields a median of 22 nodes per patient with a range of 10-43. Dr. Herr went on to demonstrate that overall survival and local recurrence-free survival are improved when comparing the outcome of a standard dissection to a limited dissection or no dissection.

Additionally, in his analysis of SWOG study 8710, he found overall survival was improved for both node-positive and node-negative patients when more than 10 lymph nodes were removed.

Dr. Herr concluded that a more extensive lymph node dissection resulted in better staging, improved surgical margins that resulted in a reduction of local recurrence, and better therapy as indicated by improved survival.

He felt this resulted in a better cystectomy and that the extent of the lymph node dissection defined the quality of the surgery and the surgeon.

Presented by Harry W. Herr, MD, at the Annual Meeting of the AUA - New York Section - September 6 - 13, 2008 - Berlin, Germany

Reported by UroToday.com Contributing Editor Mitchell C. Benson, MD

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