Association of super-extended lymphadenectomy at radical cystectomy with perioperative complications and re-hospitalization.

ABSTRACT: PURPOSE:We performed a retrospective analysis of patients treated with radical cystectomy and lymphadenectomy (LAD) for bladder cancer to assess the differential association of the extent of LAD with perioperative complications and re-hospitalization. MATERIALS AND METHODS:LAD templates were defined as limited (lLAD?=?external, internal iliac and obturator), extended (eLAD?=?up to crossing of ureter and presacral lymph nodes), and super-extended (sLAD?=?up to the inferior mesenteric artery). Logistic regression models investigated the association of LAD templates with intraoperative, 30- and 30-90-day postoperative complications, as well as re-hospitalizations within 30 and 30-90 days. RESULTS:A total of 284 patients were available for analysis. sLAD led to a higher lymph-node yield (median 39 vs 13 for lLAD and 31 for eLAD, p??500 ml (OR 1.3, 95% CI 1.08-1.49, p?=?0.003) but not with intraoperative transfusion, operation time, or length of hospital stay (p?>?0.05). Overall, 11 (4%) patients were readmitted within 30 days and 50 (17.6%) within 30-90 days. The 30- and 30-90-day mortality rates were 2.8% and 1.4%, respectively. On logistic regression, LAD template was not associated with postoperative complications or re-hospitalization rates. CONCLUSIONS:sLAD leads to higher lymph-node yield and N2/N3 rate but not to higher complication rate compared to lLAD and eLAD. With the advent of novel adjuvant systemic therapies, precise nodal staging will have a crucial role in patients counseling and clinical decision making.

SUBMITTER: D'Andrea D 

PROVIDER: S-EPMC6954123 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature