�UroToday.com - The practice of lymphadenectomy during radical cystectomy for muscle invasive bladder cancer is not standardized. There is a wide edition in the number of nodes retrieved. Recent studies suggest that both the number of nodes remote and the method of submission of lymph leaf node specimens affect the treatment outcome. Some recent written document have likewise indicated that the lymph node specimens separately retrieved and submitted for pathology have a greater number of nodes compared to en axis resection. In the present study, we sought to identify if there was a difference in the number of nodes retrieved between on an individual basis retrieved and submitted pathological specimens and specimens from en axis resection.
Guidelines for the treatment of muscle-invasive bladder cancer by the European Association of Urology recommend limited pelvic node dissection, consisting of removal of the tissue in the obturator fossa in patients undergoing surgery with a curative intent.
Several authors have famous an improved 5-year survival rate with extensive pelvic lymph node dissection in the patients with node-involved bladder crab. Some investigators have noted that the quality of radical cystectomy procedure is judged by number of nodes retrieved.
They establish that a minimum of 9 nodes was needed to be examined to accurately assess nodal involvement. They likewise found that survival improved in both patients with and without node engagement as the number of the removed nodes increased.
They too evaluated the impact of submitting nodes en bloc or as separate packages and suggested that submitting nodes as separate packages not only when is easier, but as well optimizes the evaluation and number of the lymph nodes retrieved. Some studies indicate that lymphadenectomy in combination with RC can cure a small fraction of node-positive patients
We evaluated data on 77 patients with radical cystectomy and either standard pelvic lymph leaf node dissection or en axis lymphadenectomy were reviewed. Nodal dissection specimens during standard lymphadenectomy were sent for pathology examination in 6 separate containers marked as external iliac, internal iliac, and obturator groups from both sides. en bloc dissection specimens were sent in 2 containers marked as the right and the left wing pelvic nodes. Clinical and pathological findings of these two groups were compared in footing of the number of dissected lymph nodes, numeral of nodes with metastasis, lymph node density, and clinical outcomes. There were 34 patients with standard lymph client dissection and 43 with en axis lymphadenectomy. The median numbers pool of nodes removed per patient were 15.5 (range, 4 to 48) and 7.0 (kitchen stove, 1 to 24) in those with standard and en axis lymphadenectomy, respectively (P en bloc resection. Obturator nodes were the most normally involved nodes in our study.
We found that the number of the nodes retrieved per specimen increases significantly if dissection and submission of the nodes is done in the anatomically defined areas rather than en bloc submission.
Written by M. Hammad Ather, FCPS (Urol.), as section of Beyond the Abstract on UroToday.com
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