LIMITED LYMPH NODE DISSECTION DURING RADICAL CYSTECTOMY UNDERMINE CANCER CONTROL: A 12-YR SINGLE CENTRE EXPERIENCE

Introduction & Objectives: Lymph node dissection (LND) should be considereda key step of radical cystectomy(RC) but there is not yet consensus on its optimaltemplate and its therapeutic role.Materials & Methods: Between January 1998 and December 2009 data of 850consecutive RCs performed at our Institute were collected in a prospectivelymaintaineddatabase. Out of 850 patients, 81 patients where lost at follow-up and595 with non-metastatic pure urothelial carcinoma not undergone neoadjuvanttreatments were selected. All patients underwent RC and pelvic lymph-nodedissection(LND). The template was chosen by surgeon and templates wererecorded as standard when obturator, internal, external, common iliac andpresacral lymph nodes were sent to pathologist and as limited if one or more ofthese lymph node sites where not removed. The prognostic role of LND extensionwas analyzed with univariate and multivariate Cox regression analyses togetherwith common prognostic factors.Results: Statistically significant variables at univariate analysis were lymph nodedensity (p<0.001), pN (p=0.024), pT (p=0.003), lymph node count (p=0.001) andLND extension (p<0.001). Statistically significant different were found within all pNsubgroups but pN3 where the survival benefit of a standard LND did not reachstatistical threshold. (Fig 1) At stepwise Cox regression analysis only lymph nodedensity (p<0.001) and lymph node dissection extension (p<0.001) proved to haveindependent role on CSS.Conclusions: A LND up to aortic bifurcation improves cancer specific survival andshould be integral part of RC.