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Radical cystectomy with super‐extended lymphadenectomy: impact of separate vs en bloc lymph node submission on analysis and outcomes
Author(s) -
Zehnder Pascal,
Moltzahn Felix,
Mitra Anirban P.,
Cai Jie,
Miranda Gus,
Skinner Eila C.,
Gill Inderbir S.,
Daneshmand Siamak
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12956
Subject(s) - cystectomy , lymphadenectomy , medicine , lymph node , bladder cancer , dissection (medical) , lymph , stage (stratigraphy) , urology , gastroenterology , surgery , nuclear medicine , cancer , pathology , biology , paleontology
Objective To update our previous analysis of the clinical and pathological impact of the change in the submission of lymphadenectomy specimens from en bloc to 13 separate anatomically defined packets, which took place at the U niversity of S outhern C alifornia in M ay 2002, and to determine whether lymph node ( LN ) packeting resulted in any change in oncological outcomes. Patients and Methods A total of 846 patients who underwent radical cystectomy ( RC ) with super‐extended LN dissection for cTxN0M0 bladder cancer between J anuary 1996 and D ecember 2007 were identified. Specimens of 376 patients were sent en bloc (group 1), and specimens of 470 patients were sent in 13 separate anatomical packets (group 2). Results The pathological tumour stage distribution and the proportion of LN ‐positive patients (group 1: 82 patients [22%] versus group 2: 99 patients [21%]; P = 0.80) were similar between the two groups: the median [range] number of total LNs identified increased significantly (group 1: 32 [10–97] versus group 2: 65 [10–179]; P < 0.001). LN density decreased (group 1, 11% versus group 2, 4%; P = 0.005). The median [range] number of positive LNs removed was similar (group 1: 0 [0–30] versus group 2: 0 [0–97]; P = 0.87). No nodal stage shift was observed. The 5‐year overall survival (group 1: 58% versus group 2: 59%; P = 0.65) and recurrence‐free survival rates (group 1: 68% versus group 2: 70%; P = 0.57) were similar. Conclusions The incidence of patients with positive LNs remained unchanged, regardless of how the LN specimen was submitted. Submitting 13 separate nodal packets significantly increased the total LN yield, but did not result in a significant increase in the number of positive LNs or a consecutive nodal stage shift and did not affect oncological outcomes. Based on these results LN density is not an accurate prognosticator.