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The Role of Pelvic Lymphadenectomy at the Time of Radical Cystectomy for Bladder Cancer

  • Samuel D. Kaffenberger
  • Todd M. MorganEmail author
  • Anne K. Schuckman
Chapter

Abstract

Pelvic lymphadenectomy at the time of radical cystectomy is a standard therapeutic adjunct which has been shown to improve both staging and survival for patients with muscle-invasive bladder cancer. However, there exists great controversy in determining the optimal extent of lymphadenectomy as well as in defining appropriate quality metrics for assessing the completeness of lymph node dissection. In this chapter, the anatomy of pelvic lymphadenectomy templates is defined, the available evidence in support of extended lymphadenectomy is summarized and appraised, and the role of lymphadenectomy in patients with clinical node-positive disease is visited. We also critically evaluate the utilization of lymph node counts as a surrogate for lymphadenectomy completeness and address possible alternatives. Due to the intrinsic limitations of observational studies, it is not yet certain what the optimal extent of lymphadenectomy is and ongoing clinical trials to address these questions are therefore reviewed.

Keywords

Bladder cancer Muscle-invasive Pelvic lymphadenectomy Radical cystectomy Staging Lymphadenectomy extent Lymph node count Extended pelvic lymphadenectomy Lymph node mapping Robotic surgery 

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Samuel D. Kaffenberger
    • 1
  • Todd M. Morgan
    • 2
    Email author
  • Anne K. Schuckman
    • 3
  1. 1.Department of Urologic SurgeryVanderbilt UniversityNashvilleUSA
  2. 2.Department of UrologyUniversity of MichiganAnn ArborUSA
  3. 3.USC Institute of UrologyKeck Medical Center of the University of Southern CaliforniaLos AngelesUSA

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