Is bilateral extended pelvic lymphadenectomy necessary for strictly unilateral invasive bladder cancer?

Details

Serval ID
serval:BIB_92B69AFAD612
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Is bilateral extended pelvic lymphadenectomy necessary for strictly unilateral invasive bladder cancer?
Journal
The Journal of urology
Author(s)
Roth B., Zehnder P., Birkhäuser F.D., Burkhard F.C., Thalmann G.N., Studer U.E.
ISSN
1527-3792 (Electronic)
ISSN-L
0022-5347
Publication state
Published
Issued date
05/2012
Peer-reviewed
Oui
Volume
187
Number
5
Pages
1577-1582
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
We determined the necessary extent of pelvic lymph node dissection in patients with strictly unilateral bladder cancer.
A total of 40 patients with cystectomy and unilateral bladder cancer preoperatively underwent flexible cystoscopy guided injection of radioactive technetium into the contralateral bladder wall. Preoperatively single photon emission computerized tomography was done in all cases to detect and localize radioactive lymph nodes. Radioactive lymph nodes were confirmed intraoperatively by a γ probe and removed separately. Backup extended pelvic lymph node dissection and ex vivo examination of the whole specimen with a γ camera were done to preclude missed radioactive lymph nodes. Single photon emission computerized tomography and intraoperative findings were used to generate a 3-dimensional projection model of each lymph node site.
A total of 228 radioactive lymph nodes (median 6, range 1 to 17) were detected, including 193 (85%) on the ipsilateral side of injection and 35 (15%) on the contralateral side. Of the contralateral lymph nodes 6%, 5% and 4% were in the external iliac, obturator fossa and common iliac region, respectively, but none were in the contralateral internal iliac region. At least 1 radioactive lymph node per patient was detected on the ipsilateral side. Additional lymphatic drainage to the contralateral side was found in 40% of patients.
Crossover lymphatic drainage is a common phenomenon and unilateral pelvic lymph node dissection would have missed radioactive lymph nodes in 40% of patients. However, we noted no lymphatic drainage to the contralateral internal iliac region. Thus, when bladder tumors are strictly unilateral, contralateral pelvic lymph node dissection can be limited to the obturator fossa, and the external and common iliac regions. Consequently preserving the contralateral autonomic nerves situated close to the internal iliac vessels does not compromise surgical radicality.
Keywords
Aged, Aged, 80 and over, Cystectomy/methods, Female, Humans, Lymph Node Excision/methods, Lymphatic System/pathology, Male, Middle Aged, Neoplasm Invasiveness, Prospective Studies, Tomography, Emission-Computed, Single-Photon, Urinary Bladder Neoplasms/pathology, Urinary Bladder Neoplasms/surgery
Pubmed
Web of science
Create date
08/01/2021 15:29
Last modification date
09/01/2021 6:26
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