Surgical Factors Influence Bladder Cancer Outcomes: A Cooperative Group Report

Abstract

Surgical factors influence bladder cancer outcomes after cystectomy, after adjustment for pathologic factors and neoadjuvant chemotherapy usage.

Lymph node density: surrogate marker for quality of resection in bladder cancer?

“…However, there are variations in outcome, even among high-volume, experienced surgeons, suggesting that surgical technique rather than experience may independently affect outcome. In a multi-institutional study, improved surgical quality (margin status and > ten lymph nodes obtained) significantly correlated with better survival than pathological stage, nodal status, patient age and chemotherapy status [11]. One expert panel went so far as to conclude that, to be considered 'proficient' at radical cystectomy, surgeons should perform at least ten radical cystectomies per year with a minimum of 10-14 nodes obtained [12].…”

Mining the data on UTUC management

“…3 Routine performance and extent of lymph node dissection is clearly associated with survival gains in the bladder cancer literature. 10 The large majority of radical cystectomies, however, are performed with a known diagnosis of muscle invasion (stage ≥pT2), whereas 50.3% of NU specimens in the current study were for pT1 disease, and clinical staging remains a significant preoperative challenge. Previous studies have found from 0-6% node-positivity in T1 disease, compared with 24% to 35% for T3 disease.…”

Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

“…It is also, for example, well known that surgical technique has a major impact on outcome in bladder cancer and therefore a nomogram based on a study population from centers of excellence may not be applicable outside these centers [2].…”