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Lymph Node Metastasis in Bladder Cancer.

Liedberg, Fredrik LU and Månsson, Wiking LU (2006) In European Urology 49(1). p.13-21
Abstract
Objective: We reviewed the literature on nodal staging in patients with bladder cancer treated with radical cystectomy and lymphadenectomy. Results: Fractionating the lymph node specimen significantly increases the node count, whereas results are contradictory as to whether that increase improves detection of positive nodes. Pathoanatomic data indicate that extending lymph node dissection to the aortic bifurcation improves nodal staging. That approach might be beneficial, especially in cases of T3/T4a tumours, which more often have lymph node metastases above the iliac bifurcation as compared to less advanced tumours. In node-negative patients, extended lymph node dissection probably removes undetected micrometastases and thereby increases... (More)
Objective: We reviewed the literature on nodal staging in patients with bladder cancer treated with radical cystectomy and lymphadenectomy. Results: Fractionating the lymph node specimen significantly increases the node count, whereas results are contradictory as to whether that increase improves detection of positive nodes. Pathoanatomic data indicate that extending lymph node dissection to the aortic bifurcation improves nodal staging. That approach might be beneficial, especially in cases of T3/T4a tumours, which more often have lymph node metastases above the iliac bifurcation as compared to less advanced tumours. In node-negative patients, extended lymph node dissection probably removes undetected micrometastases and thereby increases disease-free survival. Four studies suggested that a minimum of 8, 10, 10-14, and 16 nodes must be removed, to improve survival, and in another investigation aortic bifurcation was proposed as the upper limit for dissection. Some patients with positive nodes can be cured by surgery alone, even those with gross adenopathy. There is no evidence that extended lymphadenectomy increases surgery-related morbidity. The TNM classification is apparently insufficient for stratifying node-positive patients because several larger cystectomy series could not verify differences in survival between N groups. Conclusions: Fractionating the lymphadenectomy specimen increases the lymph node count. In node-negative patients, more meticulous and extended lymph node dissection (8-16 nodes or to the aortic bifurcation) probably improves disease-free survival by removing undetected micrometastases. Patients with positive lymph nodes should also be offered radical cystectomy. (c) 2005 Elsevier B.V. All rights reserved. (Less)
Please use this url to cite or link to this publication:
author
and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
lymph node metastasis, lymphadenectomy, bladder cancer
in
European Urology
volume
49
issue
1
pages
13 - 21
publisher
Elsevier
external identifiers
  • pmid:16203077
  • wos:000234576900005
  • scopus:29044437466
ISSN
1873-7560
DOI
10.1016/j.eururo.2005.08.007
language
English
LU publication?
yes
id
95699945-c143-41f3-b47e-585a0d447ced (old id 144878)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16203077&dopt=Abstract
date added to LUP
2016-04-01 15:46:57
date last changed
2021-10-03 03:30:18
@article{95699945-c143-41f3-b47e-585a0d447ced,
  abstract     = {Objective: We reviewed the literature on nodal staging in patients with bladder cancer treated with radical cystectomy and lymphadenectomy. Results: Fractionating the lymph node specimen significantly increases the node count, whereas results are contradictory as to whether that increase improves detection of positive nodes. Pathoanatomic data indicate that extending lymph node dissection to the aortic bifurcation improves nodal staging. That approach might be beneficial, especially in cases of T3/T4a tumours, which more often have lymph node metastases above the iliac bifurcation as compared to less advanced tumours. In node-negative patients, extended lymph node dissection probably removes undetected micrometastases and thereby increases disease-free survival. Four studies suggested that a minimum of 8, 10, 10-14, and 16 nodes must be removed, to improve survival, and in another investigation aortic bifurcation was proposed as the upper limit for dissection. Some patients with positive nodes can be cured by surgery alone, even those with gross adenopathy. There is no evidence that extended lymphadenectomy increases surgery-related morbidity. The TNM classification is apparently insufficient for stratifying node-positive patients because several larger cystectomy series could not verify differences in survival between N groups. Conclusions: Fractionating the lymphadenectomy specimen increases the lymph node count. In node-negative patients, more meticulous and extended lymph node dissection (8-16 nodes or to the aortic bifurcation) probably improves disease-free survival by removing undetected micrometastases. Patients with positive lymph nodes should also be offered radical cystectomy. (c) 2005 Elsevier B.V. All rights reserved.},
  author       = {Liedberg, Fredrik and Månsson, Wiking},
  issn         = {1873-7560},
  language     = {eng},
  number       = {1},
  pages        = {13--21},
  publisher    = {Elsevier},
  series       = {European Urology},
  title        = {Lymph Node Metastasis in Bladder Cancer.},
  url          = {https://lup.lub.lu.se/search/files/4470135/625018.pdf},
  doi          = {10.1016/j.eururo.2005.08.007},
  volume       = {49},
  year         = {2006},
}