Feasibility of lymphadenectomy in laparoscopic radical cystectomy

Abstract

Objectives: The number of lymph nodes obtained through lymphadenectomy during radical cystectomy has prognostic and therapeutic value. We analyzed the number of nodes obtained during laparoscopic radical cystectomy to assess whether this approach allows satisfactory lymphadenectomy.

Methods: A total of 80 consecutive laparoscopic radical cystectomies with lymphadenectomy were performed by the same surgical team from 2005 to 2008. The male/female ratio was 5.7:1, the mean age was 65.3 years (range 47-87), and average body mass index was 26.7 kg/m(2) (range 20.6-40.1). Iliac-obturator lymphadenectomy up to the aortic bifurcation was performed after excising and pocketing the bladder. We analyzed the total number of lymph nodes identified by the pathologist and investigated a possible correlation with the variables presumably related to anatomic characteristics and other circumstances.

Results: The mean operative time of this step was 32 minutes (range 17-70). Minor vascular morbidity was present in 5 cases (6.25%). The average number of lymph nodes obtained was 22.3 (range 7-74, median 21). In 75 cases (93.8%), ≥10 nodes were obtained, and in 33 cases (41.2%), lymph node metastasis was diagnosed. No association or correlation was found in the number of nodes extracted regarding age, body mass index, or number of positive nodes. Also, no differences were found in association with gender, use of induction therapy, or the indication for cystectomy.

Conclusions: Laparoscopic lymphadenectomy performed at radical cystectomy achieved an adequate number of lymph nodes. This technique did not entail an important increase in the duration of surgery. The complication rate was low. In experienced hands, laparoscopic lymphadenectomy is feasible and seems a secure oncologically correct procedure.