Cattaneo Francesco, Motterle Giovanni, Zattoni Filiberto, Morlacco Alessandro, Dal Moro Fabrizio
Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy.
Clínica Urologica, Ospedale "Santa Maria della Misericordia", Università di Udine, Udine, Italy.
Front Surg. 2018 Oct 5;5:62. doi: 10.3389/fsurg.2018.00062. eCollection 2018.
Lymph node dissection (LND; PLND: pelvic LND) is an essential component of radical cystectomy (RC) for bladder cancer (BC). However, the optimal anatomical extent of LND and its potential therapeutic role are still controversial: as we will explain, the extent of LND dissection is a predictor of survival and local recurrence but what is an adequate extension is still unclear. Moreover, there is large uncertainty about the role of surgery in patients with clinically-positive nodes. In this review we will provide a synthesis of the available evidence on this highly debated topic. Overall, the studies presented in this work support the idea that extended lymphadenectomy could provide optimal diagnostic and possibly therapeutic results in cN- patients. In cN+ patients, post chemotherapy surgery may be considered especially in subjects who have a good response to CHT, although definitive evidence is still needed. Finally, the final results of randomized trials are eagerly awaited to draw definitive conclusions of the role of PLND in BC.
淋巴结清扫术（LND；PLND：盆腔淋巴结清扫术）是膀胱癌（BC）根治性膀胱切除术（RC）的重要组成部分。然而，LND的最佳解剖范围及其潜在的治疗作用仍存在争议：正如我们将解释的，LND清扫范围是生存和局部复发的预测指标，但何种范围足够仍不清楚。此外，手术在临床淋巴结阳性患者中的作用存在很大不确定性。在本综述中，我们将综合关于这一备受争议话题的现有证据。总体而言，本研究中的各项研究支持这样一种观点，即扩大淋巴结清扫术可为cN-患者提供最佳诊断及可能的治疗效果。在cN+患者中，化疗后手术可予以考虑，尤其是对化疗有良好反应的患者，尽管仍需要确凿证据。最后，热切期待随机试验的最终结果，以得出PLND在膀胱癌中作用的确切结论。
