USC Institute of Urology, Keck School of Medicine, Los Angles, California, USA.
Curr Opin Urol. 2010 Sep;20(5):414-20. doi: 10.1097/MOU.0b013e32833c9194.
Radical cystectomy with pelvic lymph node dissection (PLND) is the preferred treatment for invasive bladder cancer. It not only results in the best disease-free term survival rates, but also provides the most accurate disease staging and most effective local symptom control. Recent investigations have demonstrated a clinical benefit to performance of an extended PLND, including all lymphatic tissue to the level of the aortic bifurcation. This review will summarize recent findings regarding the clinical benefits of radical cystectomy with extended lymphadenectomy, and will also examine the latest surgical techniques for optimizing the performance of this technically demanding procedure.
Recent studies have demonstrated increased recurrence-free survival and overall survival rates in patients undergoing radical cystectomy with extended PLND, even in cases of pathologically lymph node negative disease. The growing use of minimally invasive techniques has prompted interest in robotic radical cystectomy and extended PLND, and recent reports have demonstrated the feasibility of this technique. The standardization of extended PLND templates has also been a focus of contemporary research.
Contemporary research strongly suggests that all patients undergoing radical cystectomy for bladder cancer should undergo concomitant extended PLND. Randomized trials are still needed to confirm the benefits of extended over 'standard' PLND, and to clarify which patients may receive the greatest benefit from this procedure.
根治性膀胱切除术联合盆腔淋巴结清扫术（PLND）是浸润性膀胱癌的首选治疗方法。它不仅能获得最佳的无病生存期生存率，还能提供最准确的疾病分期和最有效的局部症状控制。最近的研究表明，进行扩大的 PLND 具有临床获益，包括所有淋巴组织至主动脉分叉水平。这篇综述将总结根治性膀胱切除术联合扩大淋巴结清扫术的最新临床获益发现，并探讨最新的外科技术，以优化这一技术要求高的手术。
最近的研究表明，在接受根治性膀胱切除术联合扩大 PLND 的患者中，即使在病理淋巴结阴性的情况下，无复发生存率和总生存率也有所提高。微创技术的广泛应用激发了人们对机器人根治性膀胱切除术和扩大 PLND 的兴趣，最近的报告证明了该技术的可行性。扩大 PLND 模板的标准化也是当代研究的重点。
目前的研究强烈表明，所有接受膀胱癌根治性膀胱切除术的患者都应同时进行扩大 PLND。仍需要随机试验来证实扩大 PLND 优于“标准”PLND 的益处，并阐明哪些患者可能从该手术中获益最大。
