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. 2013 Aug 12:5:121-8.
doi: 10.2147/RRU.S32333.

Pelvic lymph node dissection in the context of radical cystectomy: a thorough insight into the connection between patient, surgeon, pathologist and treating institution

Roland Seiler  1 , George N Thalmann  1 , Pascal Zehnder  1
Affiliations

Pelvic lymph node dissection in the context of radical cystectomy: a thorough insight into the connection between patient, surgeon, pathologist and treating institution

Roland Seiler et al. Res Rep Urol. .

Abstract

Pelvic lymph node dissection (PLND) in patients with bladder cancer varies widely in extent, technique employed, and pathological workup of specimens. The present paper provides an overview of the existing evidence regarding the effectiveness of PLND and elucidates the interactions between patient, surgeon, pathologist, and treating institution as well as their cumulative impact on the final postoperative lymph node (LN) staging. Bladder cancer patients undergoing radical cystectomy with extended PLND appear to have better oncologic outcomes compared to patients undergoing radical cystectomy and limited PLND. Attempts have been made to define and assess the quality of PLND according to the number of lymph nodes identified. However, lymph node counts depend on multiple factors such as patient characteristics, surgical template, pathological workup, and institutional policies; hence, meticulous PLND within a defined and uniformly applied extended template appears to be a better assurance of quality than absolute lymph node counts. Nevertheless, the prognosis of the patients can be partially predicted with findings from the histopathological evaluation of the PLND specimen, such as the number of positive lymph nodes, extracapsular extension, and size of the largest LN metastases. Therefore, particular prognostic parameters should be addressed within the pathological report to guide the urologist in terms of patient counseling.

Keywords: bladder cancer; outcome; pathological workup; postoperative staging.

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Figures

Figure 1
Figure 1
Images of two histopathological lymph node slides. Notes: (A) Described macroscopically as containing four embedded lymph nodes, (B) and containing one sliced lymph node. This information made the lymph node counting both easier and more accurate.
Figure 2
Figure 2
Extracapsular extension of lymph node metastases. Notes: Lymph node metastasis of urothelial bladder cancer perforating the lymph node capsules and extending to the perinodal soft tissue.
See this image and copyright information in PMC

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