The Usefulness of Lymphadenectomy in Bladder Cancer—Current Status

Małkiewicz, Bartosz; Kiełb, Paweł; Gurwin, Adam; Knecht, Klaudia; Wilk, Karol; Dobruch, Jakub; Zdrojowy, Romuald

doi:10.3390/medicina57050415

Cited by 13 publications

(12 citation statements)

References 129 publications

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“…As Bruins et al show in their systematic review, performing lymph node dissection confers favourable outcomes compared with no lymph node dissection for patients undergoing radical cystectomy in MIBC, and should be routinely performed for this cohort [67]. Despite weak evidence based on retrospective, non-randomised studies with high risks of bias and confounding, there appears to be some consensus on the extended PLND (e-PLND) showing better recurrence-free survival (RFS) and disease-specific survival (DSS) than lesser degrees of dissection [67][68][69][70]. However, the anatomical boundaries of e-PLND (which some argue is up to the level of the inferior mesenteric artery) are not consistent across studies [71].…”

Section: Discussionmentioning

confidence: 99%

Methods of Sentinel Lymph Node Detection and Management in Urinary Bladder Cancer—A Narrative Review

et al. 2022

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Introduction: Detection of lymph node status in bladder cancer significantly impacts clinical decisions regarding its management. There is a wide range of detection modalities for this task, including lymphoscintigraphy, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, positron emission tomography, and fluoroscopy. We aimed to study the pre- and intraoperative detection modalities of sentinel lymph nodes in urinary bladder cancer. Method: This narrative review was performed by searching the PubMed and EMBASE libraries using the following search terms: (“Transitional cell carcinoma of the bladder” OR “urothelial cancer” OR “urinary bladder cancer” OR “bladder cancer”) AND ((“sentinel lymph node”) OR (“lymphatic mapping”) OR (“lymphoscintigraphy”) OR (“lymphangiography”) OR (“lymph node metastases”)). Studies analysing the effectiveness and outcomes of sentinel lymph node detection in bladder cancer were included, while non-English language, duplicates, and non-article studies were excluded. After analysing the libraries and a further manual search of bibliographies, 31 studies were included in this paper. We followed the RAMESES publication standard for narrative reviews to produce this paper. Results: Of the 31 studies included, 7 studies included multiple detection methods; 5 studies included lymphoscintigraphy; 5 studies included computed tomography and/or single-photon emission computed tomography; 5 studies included fluoroscopy; 4 studies included magnetic resonance imaging; and 5 studies included positron emission tomography. Discussion: Anatomical, radioactive, and functional detection modalities have been studied independently and in combination. The consensus is that preoperative detection with imaging helps guide surgical management and intraoperative detection methods help capture any lymph nodes that may have been missed. Each of these types of detection represent their own set of benefits and drawbacks, but there is currently limited evidence to support any change in overall practice to replace conventional staging.

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Section: Discussionmentioning

confidence: 99%

Methods of Sentinel Lymph Node Detection and Management in Urinary Bladder Cancer—A Narrative Review

et al. 2022

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“…Определенные трудности при диагностике лимфатических узлов мочевого пузыря и других органов малого таза обусловлены вариантами паттернов лимфооттока. Данные различия объясняются особенностями анатомии данной области, вариациями отхождения кровоснабжающих органы сосудов и сопутствующих венозных стволов [8,9]. В настоящее время в практической онкологии все чаще стала применяться концепция о сигнальных («сторожевых») лимфатических узлах (СЛУ).…”

Section: оригинальные исследования введениеunclassified

Intraoperative ICG-Fluorescence Imaging of Lymph Nodes in Robot-Assisted Radical Cystectomy in Patients with Bladder Cancer

Pavlov

Урманцев

Bakeev

2023

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. Bladder cancer dominates among global health problems. Radical cystectomy is the recognized standard of care for muscle-invasive bladder cancer with bilateral pelvic lymphadenectomy as a mandatory step in the surgical procedure. The concept of sentinel lymph nodes, acting as a barrier to the spread of malignant process, can be beneficial in terms of reducing the extent of pelvic lymphadenectomy. Intraoperative imaging using indocyanine green now appears to be a contemporary and relevant method for intraoperative imaging of sentinel lymph nodes. Materials and methods. A study involving 28 patients diagnosed with bladder cancer was carried out at the clinic of the Bashkir State Medical University. All patients underwent robot-assisted radical cystectomy with intracorporeal formation of a heterotopic neobladder using Bricker technique. At the stage of pelvic lymphadenectomy, the isolated lymph nodes were evaluated and intraoperative ICG-fluorescence was performed. All lymph nodes obtained were examined microscopically and the results were interpreted taking into account the intraoperative diagnosis. Results and discussion. Intraoperative ICG fluorescence identified sentinel lymph nodes in 7 of 9 patients (77.8%, p < 0.05), with sensitivity equal to 77.8%, p < 0.05 and specificity — 87.5%, p < 0.05. Conclusion. The results proved a high reliability of the method of intraoperative lymph nodes imaging with indocyanine green in patients with muscle-invasive bladder cancer. Fluorescence navigation in cancer surgery opens up new opportunities for improving perioperative outcomes and reducing complications.

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“…Pelvic lymph node metastasis is an independent risk factor for death in urothelial carcinoma of the bladder 1 . Current evidence strongly supports performing a concurrent bilateral pelvic lymph node dissection at the time of radical cystectomy, as this provides important diagnostic and therapeutic benefits that ultimately translate to a significant survival benefit 1–7 . The American Urological Association and European Association of Urology (EAU) guidelines have strongly suggested curative intent bilateral lymph node dissection should be performed with all radical cystectomy 8 .…”

Section: Introductionmentioning

confidence: 99%

“…1 Current evidence strongly supports performing a concurrent bilateral pelvic lymph node dissection at the time of radical cystectomy, as this provides important diagnostic and therapeutic benefits that ultimately translate to a significant survival benefit. [1][2][3][4][5][6][7] The American Urological Association and European Association of Urology (EAU) guidelines have strongly suggested curative intent bilateral lymph node dissection should be performed with all radical cystectomy. 8 The debate regarding the surgical dissection template is still ongoing between the standard template and an extended template.…”

Section: Introductionmentioning

confidence: 99%

Lymph node assessment technique matters in radical cystectomy for bladder cancer

Chau

Thia

Viswambaram

et al. 2023

ANZ Journal of Surgery

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Background For patients undergoing radical cystectomy with pelvic lymph node dissection for urothelial cancer, a lymph node count of at least 16 is associated with improved cancer‐specific and overall survival. Lymph node yield is presumed to relate directly to extent of dissection and surgical quality, however limited studies have reviewed the impact of the pathological assessment process of lymph nodes on lymph node yield. Method A retrospective assessment of 139 patients who had radical cystectomy for urothelial cancer between March 2015 and July 2021 from Fiona Stanley Hospital (Perth, Australia) by a single surgeon was assessed. A change in pathological assessment process from assessment of only palpable lymph nodes to microscopic assessment of the entire submitted specimens occurred in August 2018. Patients were divided into two groups accordingly and other relevant demographic and pathological data was recorded. The impact of pathological processing technique on lymph node yield was assessed using the Student T test and logistical regression was used to assess the impact of other demographic variables. Results The mean lymph node yield was 16.2 nodes (IQR 12–23) in 54 patients in the pre‐process change group compared to 22.4 nodes (IQR 15–28.4) in 85 patients in the post‐process change group (P < 0.0001). 53.7% had 16 or more nodes in the pre‐process change group compared to 71.3% in the post‐process change group (P = 0.04). Age, BMI, and gender were not significant predictors of lymph node yield. Conclusion The current study demonstrates that the microscopic assessment of all lymph node tissue detects significantly more lymph nodes than only examining palpably abnormal tissue. Pathologic assessment protocols should be standardized to this technique to ensure the utility of lymph node yield as a quality metric.

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The Usefulness of Lymphadenectomy in Bladder Cancer—Current Status

Cited by 13 publications

References 129 publications

Methods of Sentinel Lymph Node Detection and Management in Urinary Bladder Cancer—A Narrative Review

Methods of Sentinel Lymph Node Detection and Management in Urinary Bladder Cancer—A Narrative Review

Intraoperative ICG-Fluorescence Imaging of Lymph Nodes in Robot-Assisted Radical Cystectomy in Patients with Bladder Cancer

Lymph node assessment technique matters in radical cystectomy for bladder cancer

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