To evaluate oncologic and perioperative outcomes of extended pelvic lymph node dissection (PLND) during robot-assisted radical cystectomy (RARC) based on the location of lymph node positivity (LN+).
We reviewed a tertiary center database of patients with bladder cancer who underwent extended PLND during RARC from 2004 to 2020. Patients were assigned to a standard (sPLN+) or extended (ePLN+) cohort based on LN+ location. ePLN+ patients were LN+ in one or more of the following: common iliac, presacral, aortic bifurcation, or paracaval packets. The Kaplan-Meier method estimated recurrence-free survival (RFS) and overall survival (OS). Perioperative 90-day complications were identified using the Clavien-Dindo system.
Ninety patients were included; 43 (48%) were sPLN+, and 47 (52%) were ePLN+. The median follow-up for sPLN+ and ePLN+ patients was 14.9 and 20.0 months, respectively. ePLN+ patients were older than sPLN+ patients (median age 75 vs. 68 years, p = 0.019). There were more ≤ cT1 LN+ patients in the sPLN+ cohort compared to the ePLN+ cohort (26% vs. 9%, p = 0.037). We recorded no differences in 90-day mortality or in RFS or OS between baseline and 12-year follow-up between groups (all, p > 0.05). Overall, the grade II or higher complication rate was 71%, with similar rates for the sPLN+ and ePLN+ (77% vs. 66%, p = 0.26) cohorts.
Location of LN+ does not affect oncologic outcomes in patients who underwent extended PLND. This underscores the lack of a notable therapeutic benefit beyond the standard dissection template.
Not applicable.
BMC urology. 2025 Apr 16*** epublish ***
Salvador Jaime-Casas, Ahmad Imam, Daniel J Lama, Oluwatimilehin Okunowo, Clayton S Lau, Kevin G Chan, Bertram E Yuh
Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 E Duarte Road, Duarte, 91010, CA, USA. ., Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 E Duarte Road, Duarte, 91010, CA, USA., Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, CA, USA.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40234913