Role of Lymphadenectomy in Bladder Cancer

, Tae Gyun Kwon

Review Article

The Korean Journal of Urological Oncology 2007;5(2):60-66.
Published online August 1, 2007.

Role of Lymphadenectomy in Bladder Cancer

Tae Gyun Kwon

Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea

Abstract

The role of a regional lymphadenectomy in the surgical treatment of high grade, invasive transitional cell carcinoma of the bladder has evolved over the last several decades. Although the application of a lymphadenectomy for bladder cancer is not significantly debated, the absolute extent or level of proximal dissection of the lymphadenectomy remains a controversial issue. A review of the literature should help elucidate the rationale and extent of an appropriate lymphadenectomy in patients undergoing radical cystectomy for bladder cancer. Various surgical issues of lymphadenectomy as well as prognostic factors in patients undergoing radical cystectomy for bladder cancer are examined. Recent retrospective series and multicenter prospective trials suggest that radical cystectomy with an appropriately performed lymphadenectomy provides the best survival outcomes and lowest local recurrence rates. Although the absolute limits of the lymph node dissection remain to be determined, evidence supports a more extended lymphadenectomy to include the common iliac vessels and presacral lymph nodes at cystectomy in patients who are appropriate surgical candidates. Extended lymph node dissection improves local disease control and patients survival. The extent of the primary bladder tumor (p-stage), number of lymph nodes removed, the lymph node tumor burden (tumor volume), and lymph node density (number of lymph nodes involved/number of lymph nodes removed) are all important prognostic variables in patients undergoing cystectomy with pathologic evidence of lymph node metastases. However, in the absence of controlled randomized trial, this remains a dubitable issue. (Korean J Urol Oncol 2007;5:60-66)

Key Words: Urinary bladder neoplasms, Transitional cell carcinoma, Lymph node excision, Prognosis