[Lymphadenectomy for bladder cancer. Diagnostic and prognostic significance as well as therapeutic benefit].
BACKGROUND
Pelvic lymphadenectomy for invasive bladder cancer is not a standardized procedure and its relevance for staging and prognoses is still under discussion. A number of retrospective studies have demonstrated a positive correlation between extent of lymphadenectomy and prognosis after radical cystectomy.


METHODS
In a retrospective study, we correlated the extent of lymphadenectomy with survival after radical cystectomy. Thereafter, we conducted a prospective study to investigate the limits of pelvic lymphadenectomy and the pattern of lymphatic spread.


RESULTS
Retrospectively, we found a significantly better survival for patients when 15 and more lymph nodes were removed. The individual surgeon was also evaluated as an important prognostic factor.


CONCLUSIONS
Based on retrospective data, an extended and complete pelvic lymphadenectomy improves the prognosis. The cranial border should be at least at the level of the aortic bifurcation. A prospective randomized study will have to clarify the effect of lymphadenectomy on the prognosis of patients after radical cystectomy.
Leissner
J
J
Klinik und Poliklinik für Urologie, Universitätsklinikum, Bonn. leissner@uni-bonn.de
D005858:Germany / Q000453:epidemiology; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*