Purpose: We compared recurrence patterns and survival of patients with urothelial bladder cancer undergoing radical cystectomy who either had limited or extended pelvic lymph node dissection(PLND).
Material and methods: Two series of 92 patients with mean age of 60.90+9.5 years who were treated with radical cystectomy and limited PLND(54 patients) and extended PLND(38 patients) were analyzed. Both groups were homogenous in sex, ages, grades and stages. All cases were staged N0M0 prior to radical cystectomy, and none were treated with neoadjuvant radiotherapy or chemotherapy. The mean follow up periods were 20.40+17.22 months for limited and 14.77+13.73 for extended PLND cases(p=0.58).
Results: The mean numbers of lymph nodes retrieved were 5.88+3.53(1-12) for limited and 15.55+7.30(8-36) for extended (p=0.001). Mean positive lymph node numbers were 2.36+1.56(1-7) for limited and 4.77+4.23(1-13) for extended(p=0.014). The percentages of patients with lymphatic involvements in limited and extended dissection were %22 and %23.68 respectively(p= 0.52). Four-year disease specific survival was %55.5 for limited and %85.6 for extended(p=0.26). Extent of PLND(p=0.19),number of retrieved lymph node(p=0.80)and positive number of nodes(p=0.44) had no statistically significant effect on survival in multivariate analysis. Disease confined to the bladder was the only significant predictor of survival(p= 0.0001).
Conclusion: The number of lymph node retrieved and the number of positive lymph node were higher in patients underwent Extended PLND dissection. Although extended PLND was associated with higher survival rate than limited PLND, it was not statistically significant. Extended PLND remains to be determined in terms of the region and number of lymph nodes retrieved.