title: Extent of lymphadenectomy in patients with bladder cancer undergoing radical cystectomy - a multi-institutional analysis.
abstract: Lymph node dissection (LND) performed at radical cystectomy (RC) has therapeutic and staging significance. However, the extent of LND remains controversial. The aim of this study was to analyze surgical patterns and results of LND in a contemporary series of patients with bladder cancer. This is a retrospective analysis of 113 consecutive patients subjected to RC in seven urological centres in the year 2013. The mean age of the cohort was 66.6 years. There were 49 cases of organ confined and 64 cases of locally advanced disease. Study endpoints were: status and extent of LND, number of LNs removed, and number of positive LNs. LND was performed in 102 patients (90.3%). Detailed data on the anatomical extent of LND was available in 82 patients (80.4%). Limited (lLND) and extended LND (eLND) was performed in 68.3% (n = 56) and 31.7% (n = 26) of patients, respectively. Obturator fossa LNs were removed in 84.1%, external iliac in 72.0%, internal iliac in 40.2%, common iliac in 31.7%, and presacral in 15.9% of cases. The median number of LNs removed in the whole study cohort, in patients who underwent lLND, and eLND, was 8.5, 5, and 16.5, respectively. In 28 patients (27.5%), LN metastases were diagnosed, including 6 cases (12.5%) in the organ-confined cohort and 22 cases (34.4%) in the locally advanced disease cohort. LND is an integral part of radical cystectomy in patients with bladder cancer. However, in the majority of patients, the extent of the procedure was suboptimal, potentially negatively affecting the survival and adequacy of pathological staging.
authors.affiliation: Department of Urology, Postgraduate Medical Education Centre, European Health Center, Otwock, Poland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Piotrowicz
authors.affiliation: Department of Urology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Sławomir
authors.initials: S
authors.lastname: Poletajew
authors.affiliation: Department of Urology, Independent Public Specialist John Paul II Western Hospital, Grodzisk Mazowiecki, Poland.
authors.forename: Stefan W
authors.initials: SW
authors.lastname: Czarniecki
authors.affiliation: Department of Urology, A. Jurasz University Hospital No. 1, Bydgoszcz, Poland.
authors.forename: Filip
authors.initials: F
authors.lastname: Kowalski
authors.affiliation: Department of Urology and Urological Oncology, Medical University of Lublin, Lublin, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Nowak
authors.affiliation: Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Oszczudłowski
authors.affiliation: Department of Urology, University Clinical Hospital Military Memorial Medical Academy - Central Veterans' Hospital, Medical University of Łódź, Łódź, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Sochaj
authors.affiliation: Department of Urology, Postgraduate Medical Education Centre, European Health Center, Otwock, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Dobruch
authors.affiliation: Department of Urology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Radziszewski
keywords: bladder cancer; cystectomy; lymphadenectomy; staging; survival