Is Pelvic Lymph Node Dissection Necessary Among Elderly Patients With Bladder Cancer Undergoing A Radical Cystectomy?

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Seniors / Aging
Article Date: 02 Jul 2008 - 3:00 PDT

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ORLANDO, FL (UroToday.com) - Extension of the pelvic lymph node dissection (PLND) during radical cystectomy (RC) has been proposed to improve patient survival and optimize lymph node count, a potential indicator of surgical quality. Yet, the survival benefit for elder patients with decreased life expectancy is unclear. The authors assessed the impact of PLND on the overall survival (OS) of elder bladder cancer patients undergoing RC.

The authors identified bladder cancer patients >75 years diagnosed with clinical T1-4NxMx who underwent RC from 2000-2007. Associations between OS and PLND (performed vs. not performed), gender, ASA classification, obesity (BMI >30), pathologic stage and chemotherapy (none vs. neoadjuvant or adjuvant) were assessed. A separate survival analysis of those patients that underwent PLND was performed to determine whether the LN count was associated with improved survival.

The study cohort was comprised of 134 RC cases with a mean age of 79.3 years, median survival of 22.8 months and 56 deaths (41.8%). A PLND was performed in 88.1% of cases. Of the 11.2% patients having nodal invasion, 80% had associated pT3/T4 disease. Muscle invasion (pT2+), present in 48.5%, was the only variable associated with survival, whereas PLND failed to demonstrate a significant survival advantage.. Among RC+PLND cases (n=118), T2 or higher stage remained the only significant predictor of survival (2.5 higher risk of dying compared to patients who did not have muscle invasive disease), but obtaining 12 or more lymph nodes from PLND was not.

The authors concluded that performing PLND in patients with advanced age and limited life expectancy may not confer a survival benefit and place them at unnecessary surgical risk for morbidity and complications.

Presented by Simon P Kim, MD, David P Wood, MD, Khaled S Hafez, MD, Chris R Hempel, MD, Stephanie Daignault, MD, and Cheryl T Lee, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor David P. Wood, MD

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