Role of Pelvic Lymph Node Dissection during Radical Cystectomy

Kwon WA

Department of Urology, Myongji Hospital, Hanyang University College of Medicine, Republic of Korea

^*Correspondance to: Whi-An Kwon 

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Abstract:

Radical cystectomy is considered the standard treatment for Muscle-Invasive Bladder Cancer (MIBC). However, a percentage of patients (up to 25%) who undergo this procedure are found to have metastatic lymph node deposits during the surgery. In such cases, the 5-year survival rate is reported to be around 25% to 30%. Performing Pelvic Lymph Node Dissection (PLND) during radical cystectomy can provide valuable prognostic information, including details about the disease extent, lymph node density, and spread of metastatic lymph nodes beyond their capsules. The National Comprehensive Cancer Network guidelines recommend the inclusion of PLND, covering the common iliac lymph nodes, in order to accurately stage MIBC. Besides its diagnostic value, several studies have highlighted the potential therapeutic benefits of PLND. Clinical trials have shown that PLND cohorts generally exhibit better oncological outcomes compared to non-PLND cohorts, irrespective of the pathological nodal status. This advantage is attributed to the removal of metastatic and micrometastatic tumor cells present within the lymph nodes. Despite the diagnostic and therapeutic significance of PLND in MIBC, there is ongoing debate regarding the optimal PLND approach. Currently, extended PLND is recommended for diagnostic purposes, but its therapeutic effectiveness has not been consistently demonstrated in recent preliminary randomized controlled trials. This manuscript has addressed the appropriate extent of PLND during radical cystectomy, considering its diagnostic and therapeutic importance. Based on the available evidence and randomized trials, we propose a suitable range for PLND.

Keywords:

Bladder cancer; Lymph node dissection; Radical cystectomy

Cite the Article:

Kwon WA. Role of Pelvic Lymph Node Dissection during Radical Cystectomy. Clin Oncol. 2023;8:2008..