Optimizing the Approach for Lymph Node Dissection during Laparoscopic Radical Cystectomy

Ghazi, Ahmed; Zimmermann, R.; Albodour, Amjad; Shefler, Alexander; Janetschek, Günter

doi:10.1016/j.eururo.2009.06.024

Cited by 15 publications

(9 citation statements)

References 18 publications

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“…Although there was no statistical significance in removed lymph nodes between LRCP and ORCP, the average number of removed lymph nodes was similar to that of Ghazi et al [25. ]…”

Section: Discussionsupporting

confidence: 67%

Evaluation of Open and Laparoscopic Radical Cystoprostatectomy Combined with Orthotopic Neobladder: A Single-Surgeon Experience

et al. 2013

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Aim: To compare the outcomes of laparoscopic (LRCP) and open radical cystoprostatectomy (ORCP) with orthotopic urinary diversion for muscle-invasive organ-confined bladder cancer by a single surgeon. Patients and Methods: Prospectively documented 15 LRCP and 15 ORCP patients, followed for at least 3 years, were included in our study. The demographic parameters of patients, preoperative radiologic staging, previous operations, surgical outcomes, complications, oncologic results and intermediate-term follow-up, postoperative chemotherapy and follow-up periods were recorded and evaluated. Results: The mean oncologic follow-up was 3 years. Transfusion rate, estimated blood loss, oral intake and narcotic analgesic requirement were statistically less in the LRCP group (p < 0.05). However, operation time and hospital stay were similar in both groups. The complication rates were not significantly different between the two groups. The mean number of dissected lymph nodes was 20.0 ± 1.7 in the ORCP and 22.6 ± 2.0 in the LRCP group. One patient in each group had a margin positive for bladder cancer. Conclusions: The laparoscopic approach may be feasible for muscle-invasive organ-confined bladder cancer. Furthermore, LRCP provides less blood loss, early oral intake and postoperative pain management. Additionally, continence and sexual function may be provided by LRCP as with ORCP.

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“…Although there was no statistical significance in removed lymph nodes between LRCP and ORCP, the average number of removed lymph nodes was similar to that of Ghazi et al [25. ]…”

Section: Discussionsupporting

confidence: 67%

Evaluation of Open and Laparoscopic Radical Cystoprostatectomy Combined with Orthotopic Neobladder: A Single-Surgeon Experience

et al. 2013

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“…Some authors regarded LN yield as an index of surgical quality with cystectomy [42], and surgeons always concentrated on this main part of the operation and paid more attention to the details as their experience accumulates. Removal of lymph nodes in LRC group was as easyas in the ORC group [43], [44], thus there was no statistical significance in the number of lymph nodes retrieved between LRC and ORC, however, what is interesting was that LRC group had fewer positive lymph node yield which might indicate the patients selected in LRC group were associated with less node metastasis. It is generally believed that qualified RC is indispensable for the treatment of BCa thus oncologic outcomes depend primarily on en bloc dissection of the tumor and perivesical soft tissue and a thorough PLND [45].…”

Section: Discussionmentioning

confidence: 94%

Laparoscopic versus Open Radical Cystectomy in Bladder Cancer: A Systematic Review and Meta-Analysis of Comparative Studies

Tang

Ding

et al. 2014

PLoS ONE

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Background and ObjectiveMore recently laparoscopic radical cystectomy (LRC) has increasingly been an attractive alternative to open radical cystectomy (ORC) and many centers have reported their early experiences in the treatment of bladder cancer. Evaluate the safety and efficacy of LRC compared with ORC in the treatment of bladder cancer.MethodsA systematic search of Medline, Scopus, and the Cochrane Library was performed up to Mar 1, 2013. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative, pathologic and oncological variables, and post-op neobladder function and complications.ResultsSixteen eligible trials evaluating LRC vs ORC were identified including seven prospective and nine retrospective studies. Although LRC was associated with longer operative time (p<0.001), patients might benefit from significantly fewer overall complications (p<0.001), less blood loss (p<0.001), shorter length of hospital stay (p<0.001), less need of blood transfusion (p<0.001), less narcotic analgesic requirement (p<0.001), shorter time to ambulation (p = 0.03), shorter time to regular diet (p<0.001), fewer positive surgical margins (p = 0.006), fewer positive lymph node (p = 0.05), lower distant metastasis rate (p = 0.05) and fewer death (p = 0.004). There was no significant difference in other demographic parameters except for a lower ASA score (p = 0.01) in LRC while post-op neobladder function were similar between the two groups.ConclusionsOur data suggest that LRC appears to be a safe, feasible and minimally invasive alternative to ORC with reliable perioperative safety, pathologic & oncologic efficacy, comparable post-op neobladder function and fewer complications. Because of the inherent limitations of the included studies, further large sample prospective, multi-centric, long-term follow-up studies and randomized control trials should be undertaken to confirm our findings.

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“…This parameter also allows comparison across various reports. The median number of LNs removed during a PLND ranges from 9-31 across various reports [6,10,12,16,21,[26][27][28][29]. This difference may be attributed to the different PLND templates adopted in each study; with studies with a more extensive template reporting a higher LN yield.…”

Section: Discussionmentioning

confidence: 99%

Higher nodal yield with robot-assisted pelvic lymph node dissection for bladder cancer compared to laparoscopic dissection: implications for more accurate staging

Arora

Pugliesi

Zugail

et al. 2020

Arab Journal of Urology

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Objectives: To compare the lymph node (LN) yield and adequacy of laparoscopic pelvic lymph node dissection (L-PLND) and robot-assisted PLND (R-PLND), as PLND is a fundamental component of radical cystectomy (RC) for bladder cancer (BCa), where a positive status is the most powerful predictor of disease recurrence and survival. Patents and methods: We retrospectively reviewed patients undergoing RC with PLND for BCa from January 2007 to July 2019 and grouped them in to Land R-PLND. Until 2011, patients underwent a standard PLND (S-PLND) with the cranial limit as bifurcation of common iliac artery. Since 2012, an extended PLND (E-PLND) up to aortic bifurcation has been performed. An adequate Sand E-PLND were defined as those that yielded at least 10 and 16 LNs, respectively. The groups were compared for LN yield and adequacy of PLND. Results: During the study period, 305 patients underwent minimally invasive RC in our centre, of which 274 (89.8%

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Optimizing the Approach for Lymph Node Dissection during Laparoscopic Radical Cystectomy

Cited by 15 publications

References 18 publications

Evaluation of Open and Laparoscopic Radical Cystoprostatectomy Combined with Orthotopic Neobladder: A Single-Surgeon Experience

Evaluation of Open and Laparoscopic Radical Cystoprostatectomy Combined with Orthotopic Neobladder: A Single-Surgeon Experience

Laparoscopic versus Open Radical Cystectomy in Bladder Cancer: A Systematic Review and Meta-Analysis of Comparative Studies

Higher nodal yield with robot-assisted pelvic lymph node dissection for bladder cancer compared to laparoscopic dissection: implications for more accurate staging

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