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Lymph node dissection during laparoscopic (LRC) and open (ORC) radical cystectomy due to muscle invasive bladder urothelial cancer (pT2-3, TCC)

Author(s): Piotr Chlosta | Tomasz Drewa | Jerzy Siekiera | Jarosław Jaskulski | Andrzej Petrus | Krzysztof Kamecki | Witold Mikołajczak | Mateusz Obarzanowski | Andrzej Wronczewski | Krzysztof Krasnicki | Milosz Jasinski

Journal: Videosurgery and Other Miniinvasive Techniques
ISSN 1895-4588

Volume: 6;
Issue: 3;
Start page: 127;
Date: 2011;
Original page

Keywords: laparoscopic radical cystectomy | open radical cystectomy | lymph node dissection

Aim: The aim of the study was to compare the number of nodes dissected during laparoscopic and open radical cystoprostatectomyin men or anterior exenteration in women due to muscle invasive bladder urothelial cancer (IBC).Material and methods: Fifty-one patients treated with laparoscopic radical cystectomy (LRC) and 63 with open radicalcystectomy (ORC) were compared. The LRC group consisted of 47 pT2 tumours and 4 pT3, while the ORC groupwas composed of 27 pT2 tumours and 36 pT3. During ORC external, internal, common iliac and obturator lymphnodes were removed separately, but were added and analysed together for each side. Nodes dissected from one sideduring ORC were compared to en bloc dissected nodes in the LRC group.Results: There were no complications associated with extended pelvic lymph node dissection during LRC or ORC.There were significant differences in the mean number of resected lymph nodes between LRC and ORC for pT2tumours. The laparoscopic approach allowed about 8-9 more lymph nodes to be removed than open surgery in thepT2 group. In 15% of patients with pT2 disease treated with open radical cystectomy node metastases were observed. Active disease was detected in 18% of nodes resected laparoscopically due to pT2 disease. Fourty-seven percentageof patients with pT3 disease treated with open surgery were diagnosed as harbouring metastatic lymph nodes. Thelaparoscopic group with pT3 disease was too small to analyse.Conclusions: We have found that laparoscopic radical cystectomy can be performed without any compromise inlymph node dissection. The technique of lymph node dissection (LND) during laparoscopic cystectomy (LRC) resultedin sufficient resected lymphatic tissue, especially in patients with bladder-confined tumours with a low volume oflymph nodes.

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