Introduction

Pelvic lymph node dissection (PLND) has a foundamental role during radical cystectomy (RC) in bladder cancer (Bca) patients. Some series reported the absence of sentinel lymph node in Bca patients, on the other hand, at the time no data supports the use of extended PLND since the data available from the randomized trial on this topic failed to assess significant survival benefit for patients treated with ePLND when compared patients trated with limited PLND. Therefore we sought to describe incidence and location of node metastases in patients treated with extended and super extended PLND highlighting its association with adverse pathologic features.

Methods

we evaluated 653 contemporary patients with clinically non metastatic BCa treated with RC and extended or super extended pelvic lymph node dissection (PLND) at a single tertiary care referral center between 1990 and 2013. Limited PLND is defined as the removal of obturator and internal illiac nodes. Standard included also the external illiac nodes. Extended includes also common and presacral nodes. Finally super extended PLND includes all the nodes removed within inferior mesenteric artery. We evaluated incidence of pathologycaly node metastases. Moreover we describe the location of the metastases and its association with other pathologic adverse_x000D_ features.

Results

Overall, 191 (29.3%) patients were found with pathologically node confirmed metastases. Of these, 57 (29.5%) patients were_x000D_ found with a single node metastases, while 136 (70.5%) had multiple node metastases. The vast majority of patients were found with node metastases in limited and standard templates only (n=150, 23.0%), on the other hand 43 (6.6%) patients had node metastases in the extended and super extended PLND template. Only 2 patients were found with node metastases in the extended or superextended PLND template without having concomitant node metastases in the standard template. The presence of node metastases in the extendeed or super extended PLND was found higher in pT3-pT4 patients (n=40, 93.0%) when compared to pT0-pT2 patients (n=3, 7.0%) patients (p value<0.001). On the other hand, no difference were found considering lymphovascular invasion (p=0.4), presence of carcinoma in situ (p=0.3), age (p=0.7) or gender (p=0.6).

Conclusions

We found that the majority of patients harbored node disease in the limited or standard node dissection pattern. On the other hand only a minority of patient were found with a disease in extended or super extended template without harboring a concomitant node disease in the limited pattern. Considering demographics and pathological features, only pT3-pT4 disease were associated with an increased risk of node metastases in the extended and superextended template.

Funding

none