�UroToday.com - The praxis of lymphadenectomy during radical cystectomy for muscle encroaching bladder cancer is not standardized. There is a wide variation in the number of nodes retrieved. Recent studies suggest that both the number of nodes removed and the method of submission of lymph node specimens touch on the treatment outcome. Some recent papers have too indicated that the lymph node specimens separately retrieved and submitted for pathology have a greater bit of nodes compared to en axis resection. In the award study, we sought to identify if there was a difference in the number of nodes retrieved between one by one retrieved and submitted pathologic specimens and specimens from en axis resection.
Guidelines for the treatment of muscle-invasive bladder cancer by the European Association of Urology commend limited pelvic node dissection, consisting of removal of the tissue in the obturator fossa in patients undergoing surgery with a curative aim.
Several authors have noted an improved 5-year survival of the fittest rate with extensive pelvic lymph node dissection in the patients with node-involved bladder cancer. Some investigators have noted that the quality of radical cystectomy procedure is judged by number of nodes retrieved.
They institute that a minimum of 9 nodes was required to be examined to accurately assess nodal involvement. They too found that survival improved in both patients with and without node involvement as the number of the remote nodes increased.
They besides evaluated the impact of submitting nodes en axis or as separate packages and suggested that submitting nodes as separate packages not only is easier, but likewise optimizes the evaluation and number of the lymph nodes retrieved. Some studies indicate that lymphadenectomy in combination with RC can cure a small fraction of node-positive patients
We evaluated data on 77 patients with radical cystectomy and either standard pelvic lymph node dissection or en bloc lymphadenectomy were reviewed. Nodal dissection specimens during standard lymphadenectomy were sent for pathology examen in 6 separate containers marked as external iliac, internal iliac, and obturator groups from both sides. en bloc dissection specimens were sent in 2 containers marked as the right and the left pelvic nodes. Clinical and pathological findings of these two groups were compared in footing of the number of dissected lymph nodes, number of nodes with metastasis, lymph node density, and clinical outcomes. There were 34 patients with monetary standard lymph node dissection and 43 with en bloc lymphadenectomy. The median numbers pool of nodes removed per patient were 15.5 (range, 4 to 48) and 7.0 (mountain chain, 1 to 24) in those with standard and en bloc lymphadenectomy, respectively (P en bloc resection. Obturator nodes were the most usually involved nodes in our study.
We found that the numeral of the nodes retrieved per specimen increases significantly if dissection and meekness of the nodes is done in the anatomically defined areas rather than en bloc submission.
Written by M. Hammad Ather, FCPS (Urol.), as part of Beyond the Abstract on UroToday.com
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