title: Lymph node metastasis mapping in extended lymphadenectomy to the level of the inferior mesenteric artery for bladder cancer.
abstract: BACKGROUND
  The aim of this study was to evaluate the distribution of lymph node metastasis in extended lymphadenectomy for patients with bladder cancer.
  
  
  METHODS
  We analyzed 31 patients who underwent extended lymphadenectomy at radical cystectomy for bladder cancer between April 2008 and February 2010. Specimens were evaluated as 14 separate packages from predesignated anatomical locations. The lymph node mapping was prospectively registered.
  
  
  RESULTS
  The median lymph node count was 37 (range 19-68). Ten (32%) patients had lymph node metastasis. The positive rates at each lymph node site were 0% at the left internal iliac, 13% at the left obturator, 3.2% at the left external iliac, 6.5% at the right internal iliac, 10% at the right obturator, 16% at the right external iliac, 3.2% at the left common iliac, 3.2% at the right common iliac and 6.5% at the presacral node. No lymph node metastasis was detected in the Cloquet, paracaval, aortocaval or paraaortic nodes. One (3.2%) patient had a skip metastasis from the left obturator to the presacral node.
  
  
  CONCLUSIONS
  Extended lymphadenectomy provides more accurate lymph node staging. We suggest that it is better to perform lymphadenectomy at least below the aortic bifurcation including the presacral node.
authors: Department of Urology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan. hkitamu@sapmed.ac.jp
authors: Hiroshi
authors: H
authors: Kitamura
authors: Fumiyasu
authors: F
authors: Takei
authors: Sachiyo
authors: S
authors: Nishida
authors: Takashi
authors: T
authors: Muranaka
authors: Naoya
authors: N
authors: Masumori
authors: Taiji
authors: T
authors: Tsukamoto
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