Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis

Objective To determine the need to standardize the number and location of l ymph nodes to be removed during radical cystectomy in patients with invasiv e bladder carcinoma. Patients and methods The pelvic lymph nodes from 447 patients (mean age 62. 8 years) who underwent radical cystectomy between 1986 and 1997 were evalua ted. The number of lymph nodes was correlated with the depth of invasion of the primary tumour (pT), occurrence of nodal metastases, clinical outcome, the operating surgeons and the pathologists dissecting the nodes. Results The clinical follow-up was available for 302 patients (mean follow- up 38.7 months). The mean (range) number of lymph nodes removed was 14.7 (1 -46). The number of lymph nodes removed varied significantly among differen t surgeons but not among pathologists. In pT3 and pT4 tumours, a more exten ded lymphadenectomy (greater than or equal to 16 lymph nodes) correlated wi th a higher percentage of patients with documented nodal metastases. There was a significant correlation between the number of lymph nodes removed and the tumour-free 5-year survival in patients with pT1, pT2 or pT3 tumours, and in patients with 1-5 positive lymph nodes (P < 0.01). Conclusion Extensive lymphadenectomy significantly improves the prognosis o f patients with invasive bladder cancer and represents a potentially curati ve procedure in patients with nodal metastases, including micrometastases t hat may escape detection during routine histopathological evaluation. The r esults indicate the need for a standardized lymph node dissection.