Trends in pelvic lymphadenectomy at the time of radical cystectomy: 1988 to 2004.
OBJECTIVE
Studies suggest that patients who undergo thorough lymphadenectomy for bladder cancer benefit from improved survival. We evaluated the incidence of and trends in lymphadenectomy in conjunction with radical cystectomy for bladder cancer.


METHODS
Using the Surveillance, Epidemiology and End Results registry we identified 8,072 eligible patients with bladder cancer who underwent radical cystectomy with or without lymphadenectomy from 1988 to 2004. After stratification by age group, race, stage, grade and year of diagnosis we performed logistic and linear regression to correlate variables to the mean number of lymph nodes sampled and the likelihood of undergoing lymphadenectomy (classified as 1 or more, 5 or more and 10 or more nodes removed).


RESULTS
In the final cohort 1,660 patients (21%) did not have any lymph nodes sampled at radical cystectomy. This number decreased from 37% in 1988 to 16% in 2004. During this period the mean number of lymph nodes removed increased by 2.6 nodes over all definitions of lymphadenectomy and the percentage of patients undergoing any form of lymph node dissection increased by an average of 19%. Year of diagnosis was most strongly predictive of the likelihood of undergoing lymphadenectomy and most correlative with the mean number of nodes sampled.


CONCLUSIONS
Over time there has been improvement in terms of the performance of lymphadenectomy and node counts obtained during radical cystectomy. If these trends continue the incidence and quality of lymphadenectomy should continue to increase, ultimately to the benefit of the patients being treated.
Department of Urology, University of California, Davis Medical Center, Sacramento, California 95817, USA. nicholas.hellenthal@ucdmc.ucdavis.edu
Nicholas J
NJ
Hellenthal
Michelle L
ML
Ramírez
Christopher P
CP
Evans
Ralph W
RW
deVere White
Theresa M
TM
Koppie
D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods* / Q000639:trends*; D008875:Middle Aged; D010388:Pelvis; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*