Presacral and retroperitoneal lymph node involvement in urothelial bladder cancer: Results of a prospective mapping study

Ranko Miocinovic, Michael C. Gong, Islam A. Ghoneim, Amr F. Fergany, Donna E. Hansel, Andrew J. Stephenson

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Purpose: We evaluated the incidence of positive lymph nodes in the presacral and retroperitoneal regions in patients who underwent radical cystectomy and extended pelvic lymph node dissection for urothelial bladder cancer. Materials and Methods: As part of a prospective mapping study, 143 patients underwent radical cystectomy and extended pelvic lymph node dissection for urothelial bladder cancer between 2006 and 2010. Lymph nodes from 6 separate regions were labeled, including bilateral pelvic and common iliac, presacral and retroperitoneal. We evaluated pathological features, treatment outcomes and cancer specific survival in patients with or without lymph node positive disease in the presacral and retroperitoneal regions. Results: A median of 37 lymph nodes (IQR 2749) were removed. Overall 52 (36%) patients had positive lymph nodes, of whom 24 (46%) had metastatic disease in the presacral or retroperitoneal region. Four patients (3%) had an isolated solitary positive lymph node in these 2 templates. Two-year overall survival in patients without vs with presacral/retroperitoneal lymph node positive disease was 44% (95% CI 2464) vs 25% (95% CI 545) (p = 0.11). In contrast, 2-year cancer specific survival in the 2 groups was 55% (95% CI 3377) and 29% (95% CI 751), respectively (p = 0.02). Conclusions: A substantial proportion of patients have lymph node positive disease in the presacral and retroperitoneal regions, including some with isolated and/or solitary lymph node involvement. While the limited positive lymph node burden in these templates suggests a potential therapeutic role for extending the anatomical boundaries of lymph node dissection, patient survival was poor. Extended lymph node dissection provides important staging information but to our knowledge the therapeutic benefit has yet to be definitively proved.

Original languageEnglish (US)
Pages (from-to)1269-1273
Number of pages5
JournalJournal of Urology
Volume186
Issue number4
DOIs
StatePublished - Oct 2011
Externally publishedYes

Keywords

  • cystectomy
  • lymph node excision
  • urinary bladder
  • urinary bladder neoplasms
  • urothelium

ASJC Scopus subject areas

  • Urology

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