title: Removal of more lymph nodes may provide better outcome, as well as more accurate pathologic findings, in patients with bladder cancer--analysis of role of pelvic lymph node dissection.
abstract: OBJECTIVE
  To examine the role of pelvic lymph node dissection (PLND) in patients who underwent radical cystectomy for bladder cancer. The diagnostic and therapeutic role of PLND is still controversial in bladder cancer. The extent of PLND and the necessary number of lymph nodes to remove have not been defined.
  
  
  METHODS
  This retrospective review included 146 patients with refractory superficial and muscle-invasive disease treated with radical cystectomy, regional PLND (internal iliac, external iliac, and obturator nodes) and urinary diversion from January 1990 to December 2002.
  
  
  RESULTS
  Lymph node metastases were detected in 25 patients (17.1%). The average number of nodes removed in the node-positive and node-negative patients was 13.9 and 14.2, respectively. Although no difference was found in disease-specific survival in the node-negative patients when stratified by the number of nodes removed (13 or more versus less than 13), a significant survival advantage was found in the node-positive patients with 13 or more nodes removed versus less than 13 nodes removed. The patients with four or more positive nodes had a worse outcome than those with less than four positive nodes. However, even if the patients had less than four positive nodes, the survival of patients with less than 13 nodes removed was as poor as that of the patients with four or more positive nodes.
  
  
  CONCLUSIONS
  In this series, the removal of 13 or more pelvic lymph nodes was essential for more accurate pathologic examination to predict patient outcome and contributed to an increased chance of survival.
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Ichiya
authors.initials: I
authors.lastname: Honma
authors.forename: Naoya
authors.initials: N
authors.lastname: Masumori
authors.forename: Eiji
authors.initials: E
authors.lastname: Sato
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Maeda
authors.forename: Megumi
authors.initials: M
authors.lastname: Hirobe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Itoh
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Tamakawa
authors.forename: Taiji
authors.initials: T
authors.lastname: Tsukamoto
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*