Medknow Publications on behalf of Indian Cancer Society
Abstract
Background : Diagnostic and therapeutic importance of pelvic lymph node
(LN) dissection (PLND) in radical cystectomy (RC) has gained recent
attention. A method of pathological analysis of LN affects total number
of LN removed, number of LN involved, and LN density. Objective : To
compare extended lymphadenectomy to standard lymphadenectomy in terms
of LN yield, density, and effect on survival. Materials and Methods :
From Jan 2004 - July 2009, 78 patients underwent RC whose complete
histopathological report was available for analysis. All were
transitional cell carcinoma. From July 2007 onward extended LN
dissection was started and LNs were sent in six packets. Twenty-eight
patients of standard PLND kept in group I. Group II had 23 patients of
standard PLND (LN sent in four packets), and group III had 23 patients
of extended PLND (LN sent in six packets). SPSS 15 software used for
statistical calculation. Results : Distribution of T-stage among three
groups is not statistically significant. Median number of LN harvested
were 5 (range, 1-25) in group I, 9 (range, 3-28) in group II, and 16
(range, 1-25) in group III. Although this is significant, we did not
find significant difference in number of positive LN harvested. We did
not find any patient with skip metastasis to common iliac LN in group
3. Conclusions : Separate package LN evaluation significantly increased
the total number of LN harvested without increasing the number of
positive LN and survival