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Laparoscopic extended pelvic lymph node dissection during radical cystectomy: technique and clinical outcomes
Author(s) -
Shao Pengfei,
Meng Xiaoxin,
Li Jie,
Lv Qiang,
Zhang Wei,
Xu Zhengquan,
Yin Changjun
Publication year - 2011
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/j.1464-410x.2010.09774.x
Subject(s) - medicine , cystectomy , inferior mesenteric artery , dissection (medical) , lymph node , lymphadenectomy , surgery , laparoscopy , urinary diversion , external iliac artery , bladder cancer , cancer
Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Pelvic lymph node dissection (PLND) is an obligatory step for radical cystectomy and it provides staging information and potential survival benefits. This study shows extended PLND with proximal boundary of inferior mesentery artery is safe and feasible under laparoscopy. More positive nodes can be retrieved compared to standard template. OBJECTIVE • To study the surgical techniques and clinical results of laparoscopic extended pelvic lymph node dissection during radical cystectomy. PATIENTS AND METHODS • From July 2007 to October 2009, 43 patients with bladder carcinoma received laparoscopic radical cystectomy with extended pelvic lymphadenectomy and urinary diversion. • Pelvic lymph node dissection (PLND) was first performed within extended template. • The lower part of aorta and vena cava were isolated from the bifurcation of common iliac artery to the level of the inferior mesenteric artery. • The standard template PLND was continued along the external iliac vessels, internal iliac vessels and obturator nerve. The bladder was then removed laparoscopically and urinary diversion was performed. RESULTS • All procedures were performed successfully and no open conversion occurred. The duration of the procedure for extended PLND was 90–185 min (mean 125 min) and total duration was 280–470 min (mean 329 min). • Intra‐operative blood loss was 200–1500 mL (mean 325 mL) and eight cases received transfusion. Pathological study identified transitional cell carcinoma and a negative margin in all cases. A range of 19–53 lymph nodes were dissected in the patients with a mean of 31.3. • In total, 17 positive nodes were confirmed in 11 cases. Postoperative complications included two cases of bowel obstruction, two cases of mild urine leakage and 17 cases of lymphatic leakage. CONCLUSIONS • Laparoscopic radical cystectomy with extended pelvic lymphadenectomy is indicated in selected patients with bladder cancer. • It is safe, minimally invasive and more lymph nodes can be retrieved with a higher success rate by extended pelvic lymphadenectomy.