Main Determinants of the Extent of Lymphadenectomy in Radical Cystectomy: A Study Based on Clinical Practice

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.