Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.24915/aup.35.3-4.61 |
Resumo: | Introduction: During radical cystectomy of patients with muscle-invasive bladder cancer, pelvic lymphadenectomy is used not only for an accurate staging, but also to provide local and regional control of the disease. Although recent studies evaluating the anatomical extent of lymphadenectomy recommend an extended template, the relation between the extent of lymphadenectomy and the number of dissected nodes remains controversial. The aim of this study was to determine the main predictors of the extent of lymphadenectomy in patients with bladder cancer submitted to radical cystectomy. Material and Methods: Retrospective analysis of 119 patients with muscle-invasive or selected high-risk non-muscle invasive bladder cancer submitted to radical cystectomy between 2010 and 2015 at our institution. Results: Standard and extended lymphadenectomy was performed in 87 and 22 patients, respectively. Extended template was statistically associated with a higher number of lymph nodes dissected when compared to standard lymphadenectomy, (14 vs 11 lymph nodes; p < 0.05) and showed a trend toward better overall survival, although without statistical significance (HR = 0.52, 95% CI 0.23-1.21). Extended lymphadenectomy was performed preferentially in patients undergoing an orthotopic bladder substitution (47.8%) relatively to other types of urinary diversion (around 10% - 11%). These patients had more lymph nodes dissected relatively to cutaneous ureterostomy (15 vs 8 lymph nodes), on average. Conclusion: The surgeon’s decision about the type of urinary diversion to be performed is the main determinant of the extent of lymphadenectomy in patients with bladder cancer undergoing radical cystectomy The number of retrieved lymph nodes was associated with the extent of lymphadenectomy and with a trend toward better overall survival. |
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Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical PracticePrincipais Preditores da Extensão da Linfadenectomia na Cistectomia Radical: Um Estudo Baseado na Prática ClínicaCystectomyLymph Node ExcisionUrinary Bladder NeoplasmsUrinary DiversionCistectomiaDerivação UrináriaExcisão de GânglioNeoplasias da Bexiga UrináriaIntroduction: During radical cystectomy of patients with muscle-invasive bladder cancer, pelvic lymphadenectomy is used not only for an accurate staging, but also to provide local and regional control of the disease. Although recent studies evaluating the anatomical extent of lymphadenectomy recommend an extended template, the relation between the extent of lymphadenectomy and the number of dissected nodes remains controversial. The aim of this study was to determine the main predictors of the extent of lymphadenectomy in patients with bladder cancer submitted to radical cystectomy. Material and Methods: Retrospective analysis of 119 patients with muscle-invasive or selected high-risk non-muscle invasive bladder cancer submitted to radical cystectomy between 2010 and 2015 at our institution. Results: Standard and extended lymphadenectomy was performed in 87 and 22 patients, respectively. Extended template was statistically associated with a higher number of lymph nodes dissected when compared to standard lymphadenectomy, (14 vs 11 lymph nodes; p < 0.05) and showed a trend toward better overall survival, although without statistical significance (HR = 0.52, 95% CI 0.23-1.21). Extended lymphadenectomy was performed preferentially in patients undergoing an orthotopic bladder substitution (47.8%) relatively to other types of urinary diversion (around 10% - 11%). These patients had more lymph nodes dissected relatively to cutaneous ureterostomy (15 vs 8 lymph nodes), on average. Conclusion: The surgeon’s decision about the type of urinary diversion to be performed is the main determinant of the extent of lymphadenectomy in patients with bladder cancer undergoing radical cystectomy The number of retrieved lymph nodes was associated with the extent of lymphadenectomy and with a trend toward better overall survival.Introdução: Durante a cistectomia radical de doentes com neoplasia vesical musculo-invasiva, a linfadenectomia pélvica é usada não apenas para um estadiamento preciso, mas também para controlo local e regional da doença. Apesar de estudos recentes recomendarem a realização de uma linfadenectomia extensa, a relação entre a extensão da linfadenectomia e o número de gânglios ressecados permanece controverso. O objectivo do estudo foi determinar os principais preditores da extensão da linfadenectomia em pacientes com neoplasia vesical submetidos à cistectomia radical. Material e Métodos: Análise retrospetiva de 119 doentes com neoplasia vesical musculo-invasiva ou não-invasiva de alto risco submetidos a cistectomia radical entre 2010 e 2015 na nossa instituição. Resultados: A linfadenectomia padrão e extensa foram realizadas em 87 e 22 doentes, respetivamente. A linfadenectomia extensa demonstrou um número estatisticamente superior de gânglios removidos relativamente à linfadenectomia padrão (14 vs 11 gânglios, p < 0,05) e ainda uma tendência para uma maior sobrevida global, embora sem significância estatística (HR=0,52, 95% CI 0,23-1,21). A linfadenectomia extensa foi realizada preferencialmente em pacientes submetidos a substituição ortotópica da bexiga (47,8%) relativamente a outros tipos de derivação urinária (cerca de 10% - 11%). Em média, esses doentes tiveram mais gânglios removidos durante a linfadenectomia do que os doentes submetidos a ureterostomia cutânea (15 vs 8 gânglios). Conclusão: A decisão do cirurgião quanto ao tipo de derivação urinária a ser realizada é o principal preditor da extensão da linfadenectomia em pacientes com neoplasia da bexiga submetidos à cistectomia radical. O número de gânglios removidos associou-se à extensão da linfadenectomia, com tendência para uma maior sobrevida global.Associação Portuguesa de Urologia2019-01-19T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.24915/aup.35.3-4.61oai:oai.actaurologicaportuguesa.com:article/61Acta Urológica Portuguesa; Vol. 35 No. 3-4 (2018): July-September; October-December; 6-10Acta Urológica Portuguesa; v. 35 n. 3-4 (2018): Julho-Setembro; Outubro-Dezembro; 6-102387-04192341-4022reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://www.actaurologicaportuguesa.com/index.php/aup/article/view/61https://doi.org/10.24915/aup.35.3-4.61http://www.actaurologicaportuguesa.com/index.php/aup/article/view/61/41Copyright (c) 2018 Portuguese Association of Urologyinfo:eu-repo/semantics/openAccessVale, LuísMendes, FilipaPacheco-Figueiredo, LuísAntunes-Lopes, TiagoAlturas-Silva, JoãoMartins-Silva, Carlos2022-09-21T09:04:46Zoai:oai.actaurologicaportuguesa.com:article/61Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T15:55:53.349797Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice Principais Preditores da Extensão da Linfadenectomia na Cistectomia Radical: Um Estudo Baseado na Prática Clínica |
title |
Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice |
spellingShingle |
Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice Vale, Luís Cystectomy Lymph Node Excision Urinary Bladder Neoplasms Urinary Diversion Cistectomia Derivação Urinária Excisão de Gânglio Neoplasias da Bexiga Urinária |
title_short |
Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice |
title_full |
Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice |
title_fullStr |
Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice |
title_full_unstemmed |
Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice |
title_sort |
Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice |
author |
Vale, Luís |
author_facet |
Vale, Luís Mendes, Filipa Pacheco-Figueiredo, Luís Antunes-Lopes, Tiago Alturas-Silva, João Martins-Silva, Carlos |
author_role |
author |
author2 |
Mendes, Filipa Pacheco-Figueiredo, Luís Antunes-Lopes, Tiago Alturas-Silva, João Martins-Silva, Carlos |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Vale, Luís Mendes, Filipa Pacheco-Figueiredo, Luís Antunes-Lopes, Tiago Alturas-Silva, João Martins-Silva, Carlos |
dc.subject.por.fl_str_mv |
Cystectomy Lymph Node Excision Urinary Bladder Neoplasms Urinary Diversion Cistectomia Derivação Urinária Excisão de Gânglio Neoplasias da Bexiga Urinária |
topic |
Cystectomy Lymph Node Excision Urinary Bladder Neoplasms Urinary Diversion Cistectomia Derivação Urinária Excisão de Gânglio Neoplasias da Bexiga Urinária |
description |
Introduction: During radical cystectomy of patients with muscle-invasive bladder cancer, pelvic lymphadenectomy is used not only for an accurate staging, but also to provide local and regional control of the disease. Although recent studies evaluating the anatomical extent of lymphadenectomy recommend an extended template, the relation between the extent of lymphadenectomy and the number of dissected nodes remains controversial. The aim of this study was to determine the main predictors of the extent of lymphadenectomy in patients with bladder cancer submitted to radical cystectomy. Material and Methods: Retrospective analysis of 119 patients with muscle-invasive or selected high-risk non-muscle invasive bladder cancer submitted to radical cystectomy between 2010 and 2015 at our institution. Results: Standard and extended lymphadenectomy was performed in 87 and 22 patients, respectively. Extended template was statistically associated with a higher number of lymph nodes dissected when compared to standard lymphadenectomy, (14 vs 11 lymph nodes; p < 0.05) and showed a trend toward better overall survival, although without statistical significance (HR = 0.52, 95% CI 0.23-1.21). Extended lymphadenectomy was performed preferentially in patients undergoing an orthotopic bladder substitution (47.8%) relatively to other types of urinary diversion (around 10% - 11%). These patients had more lymph nodes dissected relatively to cutaneous ureterostomy (15 vs 8 lymph nodes), on average. Conclusion: The surgeon’s decision about the type of urinary diversion to be performed is the main determinant of the extent of lymphadenectomy in patients with bladder cancer undergoing radical cystectomy The number of retrieved lymph nodes was associated with the extent of lymphadenectomy and with a trend toward better overall survival. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-01-19T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.24915/aup.35.3-4.61 oai:oai.actaurologicaportuguesa.com:article/61 |
url |
https://doi.org/10.24915/aup.35.3-4.61 |
identifier_str_mv |
oai:oai.actaurologicaportuguesa.com:article/61 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://www.actaurologicaportuguesa.com/index.php/aup/article/view/61 https://doi.org/10.24915/aup.35.3-4.61 http://www.actaurologicaportuguesa.com/index.php/aup/article/view/61/41 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2018 Portuguese Association of Urology info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2018 Portuguese Association of Urology |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Associação Portuguesa de Urologia |
publisher.none.fl_str_mv |
Associação Portuguesa de Urologia |
dc.source.none.fl_str_mv |
Acta Urológica Portuguesa; Vol. 35 No. 3-4 (2018): July-September; October-December; 6-10 Acta Urológica Portuguesa; v. 35 n. 3-4 (2018): Julho-Setembro; Outubro-Dezembro; 6-10 2387-0419 2341-4022 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799130427680620544 |