Brunocilla Eugenio, Pernetti Remigio, Martorana Giuseppe
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Anticancer Res. 2011 Jan;31(1):271-5.
Radical cystectomy is the standard treatment for patients with invasive bladder cancer. Many aspects regarding the role of concomitant pelvic lymph node dissection (PLND), its extension and the oncological impact are still under discussion.
A detailed literature review is presented to assess the impact of pelvic lymph node dissection during radical cystectomy in terms of staging and therapeutic procedure. Analysis of evidence: The study presented the role of imaging in the assessment of lymph node status, the anatomical account of bladder lymphatic drainage and the techniques for dissection. The evidence from the literature examined showed that pathological stage of the bladder, the extent of PLND in both node-negative and - positive disease, the lymph node density and the extracapsular involvement of metastatic lymph nodes are significant independent prognostic factors for disease-free survival.
Radical cystectomy with bilateral pelvic iliac lymphadenectomy is a standard treatment for high-grade, invasive bladder cancer, providing the best survival outcomes and the lowest local recurrence rates. Even if the precise extent of lymph node dissection is still not standardized, many studies support a more extended lymphadenectomy to obtain better cancer-specific survival rates without significantly increasing the morbidity or mortality of the surgery. The concept of lymph node density may become a useful prognostic variable in high-risk node-positive patients.
根治性膀胱切除术是浸润性膀胱癌患者的标准治疗方法。关于盆腔淋巴结清扫术（PLND）的作用、范围及其肿瘤学影响的许多方面仍在讨论中。
进行详细的文献综述，以评估根治性膀胱切除术中盆腔淋巴结清扫术在分期和治疗程序方面的影响。证据分析：该研究阐述了影像学在评估淋巴结状态中的作用、膀胱淋巴引流的解剖学情况以及清扫技术。文献研究证据表明，膀胱的病理分期、PLND在淋巴结阴性和阳性疾病中的范围、淋巴结密度以及转移性淋巴结的包膜外侵犯是无病生存的重要独立预后因素。
双侧盆腔髂淋巴结清扫的根治性膀胱切除术是高级别浸润性膀胱癌的标准治疗方法，可提供最佳生存结果和最低局部复发率。即使淋巴结清扫的确切范围仍未标准化，但许多研究支持更广泛的淋巴结清扫以获得更好的癌症特异性生存率，且不会显著增加手术的发病率或死亡率。淋巴结密度的概念可能成为高危淋巴结阳性患者有用的预后变量。
