Department of Urology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
Int J Clin Oncol. 2012 Feb;17(1):63-8. doi: 10.1007/s10147-011-0257-8. Epub 2011 May 25.
The aim of this study was to evaluate the distribution of lymph node metastasis in extended lymphadenectomy for patients with bladder cancer.
We analyzed 31 patients who underwent extended lymphadenectomy at radical cystectomy for bladder cancer between April 2008 and February 2010. Specimens were evaluated as 14 separate packages from predesignated anatomical locations. The lymph node mapping was prospectively registered.
The median lymph node count was 37 (range 19-68). Ten (32%) patients had lymph node metastasis. The positive rates at each lymph node site were 0% at the left internal iliac, 13% at the left obturator, 3.2% at the left external iliac, 6.5% at the right internal iliac, 10% at the right obturator, 16% at the right external iliac, 3.2% at the left common iliac, 3.2% at the right common iliac and 6.5% at the presacral node. No lymph node metastasis was detected in the Cloquet, paracaval, aortocaval or paraaortic nodes. One (3.2%) patient had a skip metastasis from the left obturator to the presacral node.
Extended lymphadenectomy provides more accurate lymph node staging. We suggest that it is better to perform lymphadenectomy at least below the aortic bifurcation including the presacral node.
本研究旨在评估膀胱癌根治性膀胱切除术后扩大淋巴结清扫术的淋巴结转移分布情况。
我们分析了 2008 年 4 月至 2010 年 2 月期间因膀胱癌行扩大淋巴结清扫术的 31 例患者。标本按预定解剖部位分为 14 个独立包进行评估。淋巴结绘图进行了前瞻性登记。
中位淋巴结计数为 37 个（范围 19-68 个）。10 例（32%）患者有淋巴结转移。每个淋巴结部位的阳性率分别为：左侧髂内 0%，左侧闭孔 13%，左侧髂外 3.2%，右侧髂内 6.5%，右侧闭孔 10%，右侧髂外 16%，左侧髂总 3.2%，右侧髂总 3.2%，骶前淋巴结 6.5%。Cloquet、腔静脉旁、腹主动脉旁或主动脉旁淋巴结无淋巴结转移。1 例（3.2%）患者从左侧闭孔淋巴结跳跃转移至骶前淋巴结。
扩大淋巴结清扫术可提供更准确的淋巴结分期。我们建议，最好在主动脉分叉以下进行淋巴结清扫术，包括骶前淋巴结。
