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The prognostic and staging value of lymph node dissection in the treatment of invasive bladder cancer

Nature Clinical Practice Urology volume 3, pages 485–494 (2006)Cite this article

Abstract

Regional lymph node dissection (LND) at the time of radical cystectomy is an essential component of the surgical management of invasive bladder cancer and might provide diagnostic and therapeutic benefits for both node-negative and node-positive patients. The benefits obtained in pathologically node-negative patients might result from more complete resection of undetected micrometastases or from a more meticulous surgical technique. Advanced nodal disease also seems to be amenable to thorough surgical resection in a subpopulation of patients with bladder cancer. Despite the growing body of evidence to support the role of a more extended LND, no guidelines regarding the optimal boundaries of LND have been established. An increased number of resected nodes and wider LND boundaries have been associated with improved local disease control and prolonged survival. Additionally, mapping series indicate that the common iliac and presacral nodal regions are more frequently involved with tumor metastases than previously recognized. Efforts to limit any unnecessary dissection in patients at low risk for metastases—a tailored approach—has been proposed, but remains unproven. From the available evidence, the most reliable diagnostic and therapeutic approach to LND includes the routine extended LND in all patients undergoing cystectomy with curative intent.

Key Points

  • A high number of lymph nodes identified in the surgical specimen is associated with a significant improvement in local disease recurrence and overall survival

  • Expansion of the lymph-node dissection to include common iliac, presacral and periaortic nodes is not associated with an increase in perioperative morbidity or mortality

  • Both pathologically node-negative and node-positive patients gain a significant survival advantage from a more extensive lymph-node dissection

  • The survival advantage associated with lymph-node dissection in node-negative patients might be associated with excision of undiagnosed micrometastases

  • Lymph-node density might be a more efficacious method for the risk stratification of node-positive patients than the current tumor-node-metastasis staging system

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Authors and Affiliations

  1. Fellow in urologic oncology, JP Stein is an Associate Professor and D Skinner is a Professor and the Chariman of the Department of Urology, at the University of Southern California, Keck School of Medicine, Los Angeles, CA, USA

    Kristin M Sanderson, Donald Skinner & John P Stein

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  1. Kristin M Sanderson
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  2. Donald Skinner
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  3. John P Stein
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Correspondence to Kristin M Sanderson.

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Sanderson, K., Skinner, D. & Stein, J. The prognostic and staging value of lymph node dissection in the treatment of invasive bladder cancer. Nat Rev Urol 3, 485–494 (2006). https://doi.org/10.1038/ncpuro0582

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