EXTRAPERITONEAL PELVIOSCOPY IN STAGING OF BLADDER-CARCINOMA AND DETECTION OF PELVIC LYMPH-NODE METASTASIS

This study was carried out to examine the efficacy of extraperitoneal pelvioscopy in detecting pelvic metastasis in patients scheduled to un dergo radical cystectomy without preoperative chemo- or radiotherapy. The results of pelvioscopy were compared with those obtained by laparo tomy. 54 consecutive patients underwent pelvioscopy without complicati ons. Three were technically insufficient. Lymphatic tissue was biopsie d in 29 (54%). Pelvioscopy demonstrated tumor dissemination in 5 patie nts (9.3%): 2 had pT4b tumor, 2 pelvic nodal metastases and 1 both. Th e remaining 49 patients with benign pelvioscopy were scheduled for lap arotomy but 7 patients did not undergo the procedure: 3 had extrapelvi c metastasis, 1 bronchial carcinoma, 1 aortic aneurysm, 1 refused surg ery and 1 had pulmonary insufficiency. Accordingly, 42 patients underw ent open exploration which demonstrated pelvic metastasis in 11: 9 had nodal metastasis, 1 a pT4b tumor and 1 both. Consequently the sensiti vity of pelvioscopy in detecting pelvic metastasis was calculated at o nly 31%. This result indicates that extraperitoneal pelvioscopy should be considered a screening procedure rather than an accurate staging p rocedure for pelvic metastasis.