Department of Urology, Aarhus University Hospital, Skejby, Aarhus Sygehus NBG, Denmark.
BJU Int. 2010 Jul;106(2):199-205. doi: 10.1111/j.1464-410X.2009.09118.x. Epub 2009 Dec 9.
To evaluate extended lymph node dissection (LND) as a nodal staging tool in the treatment of invasive carcinoma of the urinary bladder and to suggest a reasonable proximal limit of the dissection.
In all, 170 patients underwent radical cystectomy with extended LND up to the level of the inferior mesenteric artery. Specimens were evaluated as 13 separate packages from pre-designated anatomical locations. The number of LNs and presence of positive LNs (LN+) at each location was prospectively registered.
The median (range) number of LNs removed was 24 (6-62). In all, 25.3% of the patients had LN+. The median (range) number of LN+ was 2 (1-20). Advanced T-stage was correlated with a higher risk of LN+ but not to the specific location of the LN+. Two patients had LN+ above the common iliac bifurcation with no LN+ more distally located within the pelvic region. All other patients with LN+ above the common iliac bifurcation had more distally located LN+. There were no skip lesions to LNs above the aortic bifurcation.
Extended LND above the common iliac bifurcation including the presacral area provides a more accurate LN staging compared with a standard pelvic LND. Extending the limits above the aortic bifurcation is not necessary from a staging perspective.
评估扩大淋巴结清扫术（LND）作为浸润性膀胱癌治疗中的淋巴结分期工具，并提出合理的清扫近端界限。
共 170 例患者接受根治性膀胱切除术和扩大 LND 至肠系膜下动脉水平。标本从预先指定的解剖位置分为 13 个独立的包进行评估。每个部位的淋巴结数量和阳性淋巴结（LN+）的存在情况均进行前瞻性登记。
中位（范围）切除的淋巴结数量为 24（6-62）。25.3%的患者有 LN+。中位（范围）LN+数量为 2（1-20）。高级 T 期与 LN+风险增加相关，但与 LN 的具体位置无关。有 2 例患者在髂总分叉上方有 LN+，而在骨盆区域内没有更远处的 LN+。所有其他在髂总分叉上方有 LN+的患者均有更远处的 LN+。主动脉分叉上方没有跳跃性淋巴结转移。
与标准盆腔 LND 相比，扩大至髂总分叉上方包括骶前区域的 LND 可提供更准确的淋巴结分期。从分期的角度来看，将界限扩大至主动脉分叉上方是没有必要的。
