Lymph Node Metastasis in Bladder Cancer.

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Lymph Node Metastasis in Bladder Cancer. / Liedberg, Fredrik; Månsson, Wiking.

In: European Urology, Vol. 49, No. 1, 2006, p. 13-21.

Research output: Contribution to journalReview article

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TY - JOUR

T1 - Lymph Node Metastasis in Bladder Cancer.

AU - Liedberg, Fredrik

AU - Månsson, Wiking

PY - 2006

Y1 - 2006

N2 - 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.

AB - 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.

KW - lymph node metastasis

KW - lymphadenectomy

KW - bladder cancer

U2 - 10.1016/j.eururo.2005.08.007

DO - 10.1016/j.eururo.2005.08.007

M3 - Review article

VL - 49

SP - 13

EP - 21

JO - European Urology

T2 - European Urology

JF - European Urology

SN - 1873-7560

IS - 1

ER -