title: [The importance of lymphadenectomy for muscle invasive transitional cell carcinoma of the human bladder - a review of the literature].
abstract: BACKGROUND
  The extent of the lymphadenectomy (LAE) as well as the appearance of lymph node metastasis are important prognostic factors in the treatment of the muscle invasive transitional cell carcinoma of the bladder (TCC). However there is still the need to discuss the dimension of the LAE.
  
  
  METHODS
  Pubmed was searched with regard to guidelines for the treatment of muscle invasive TCC. In particular, operation techniques, the appearance of lymph node metastasis, lymph node mapping, histopathological and radiological detection methods, as well as the risk of positive lymph nodes were analysed.
  
  
  RESULTS
  The confirmation of lymph node metastasis is associated with a poorer outcome. Besides knowledge of metastasis pathways, an extensive and careful pathological reprocessing is one cornerstone of the procedure. Molecular markers seem to support the detection of micrometastasis. The extended LAE is associated with a better long-term survival rate compared to the limited LAE. New operation techniques such as laparoscopic or robot-assisted cystectomy are associated with lower peri- and postoperative morbidity, but the extended LAE is more challenging using these techniques. There are no long-term results available yet for these methods. Most data regarding lymphadenectomy and survival rate are based on retrospective studies thus decreasing the level of evidence.
  
  
  CONCLUSIONS
  An extended LAE shows retrospectively a better outcome in patients with lymph node metastasis in TCC. Therefore an extended LAE should be performed in patients with muscle invasive TCC. New methods for detecting lymph node metastasis are elevating the confirmation rate.
authors: Klinik für Urologie, Eberhard-Karls Universität Tübingen, Germany. saladin.alloussi@med.unituebingen.de
authors: S H
authors: SH
authors: Alloussi
authors: S
authors: S
authors: Huber
authors: G
authors: G
authors: Gakis
authors: A
authors: A
authors: Stenzl
authors: C
authors: C
authors: Schwentner
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis / Q000473:pathology; D009361:Neoplasm Invasiveness; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012371:Robotics / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*