Pelvic lymph node metastases from bladder cancer: Outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy

Purpose: We evaluate the outcome in patients with node positive bladder can cer with particular reference to the effect of individual characteristics o f positive nodes on survival after meticulous pelvic lymphadenectomy at cys tectomy. Materials and Methods: This prospective analysis contains 452 cases of blad der cancer staged preoperatively as N0M0, managed with pelvic lymphadenecto my and cystectomy between 1984 and 1997. A total of 83 (18%) patients with histologically confirmed node positive disease are included in our study. Results: The median overall survival of patients with positive nodes was 20 months. Median 5-year survival was 29%. Patients who survived were found w ith positive nodes at each site in the pelvis. The median survival of 57 pa tients with less than 5 positive nodes was 27 months, compared with 15 mont hs for 26 with 5 nodes or more (log-rank test p = 0.0027). Median survival of 26 patients with no lymph node capsule perforation was 93 months, compar ed with 16 months for 57 with capsule perforation (p = 0.0004). The median survival of 18 patients with a maximum diameter of lymph node metastasis up to 0.5 cm. was 64 months, compared with 16 months for 65 with nodal metast asis greater than 0.5 cm. (p = 0.024). Contralateral positive nodes were fo und in 16 of 39 (41%) patients with unilateral bladder cancer. Conclusions: Long-term survival is possible with node positive bladder canc er. Those patients with few as well as smaller and, therefore, unsuspected nodal metastases, and those without lymph node capsule perforation have the best results after removal of pelvic metastatic nodal disease. Because pat ients who survive may be found regardless of the site of pelvic nodal metas tases, meticulous bilateral pelvic lymphadenectomy is warranted in all pati ents at the time of attempted curative cystectomy for bladder cancer, parti cularly if there is no clinical evidence of nodal involvement.