Urology Department, Assiut University, Asyut, Egypt.
Pathology Department, Assiut University, Asyut, Egypt.
Int Urol Nephrol. 2024 Mar;56(3):965-972. doi: 10.1007/s11255-023-03826-4. Epub 2023 Oct 17.
To compare the oncological outcome of performing ePLND before or after RC in 200 patients in a prospective randomized manner.
From January 2014 to December 2019, 200 patients with T2-T3b N0M0 BCa were included in the current study after signing an informed consent. Patients were divided into two groups, 100 in each one. Group I underwent ePLND before RC, whereas group II underwent ePLND after RC. Postoperative evaluation included clinical, laboratory, and radiographic studies.
Patients' characteristics were comparable between both groups. The mean operative time excluding that of urinary diversion was significantly shorter in group II than in group I (p = 0.01). The mean number of LNs removed was 25 ± 6 in group I and 32 ± 8 in group II (p = 0.141). Intraoperative complications occurred in four patients in the form of external iliac artery and vein injury [two in each group (p = 0. 245)]. Postoperative complications were comparable between both groups with no statistically significant difference (p = 0.375). Oncological failure occurred in 28 patients [16 (17.6%) in group I and 12 (22%) in group II (p = 0.389)].
EPLND before and after RC has comparable oncological outcomes. The stage of the disease, the time since the first diagnosis till RC and the surgeon experience in performing meticulous ePLND are more important. In absence of oncological superiority, the timing of ePLND should be judged according to the patient-related factors to facilitate safe RC with minimal morbidity.
以前瞻性随机方式比较 200 例患者接受 RC 前或后施行扩大盆腔淋巴结清扫术（ePLND）的肿瘤学结果。
自 2014 年 1 月至 2019 年 12 月，当前研究共纳入 200 例签署知情同意书的 T2-T3b N0M0 膀胱癌患者。患者被分为两组，每组 100 例。组 1 在 RC 前行 ePLND，组 2 在 RC 后行 ePLND。术后评估包括临床、实验室和影像学研究。
两组患者的特征具有可比性。组 2 的无尿流改道术的平均手术时间明显短于组 1（p=0.01）。组 1 中移除的淋巴结平均数量为 25±6，组 2 为 32±8（p=0.141）。术中并发症有 4 例，表现为髂外动静脉损伤（每组 2 例，p=0.245）。两组的术后并发症无统计学差异（p=0.375）。28 例患者发生肿瘤学失败[组 1 中 16 例（17.6%），组 2 中 12 例（22%）（p=0.389）]。
RC 前和后施行 ePLND 的肿瘤学结果相当。疾病的分期、首次诊断到 RC 的时间以及术者施行精细 ePLND 的经验更为重要。在没有肿瘤学优势的情况下，应根据患者相关因素判断 ePLND 的时机，以便在最小发病率的情况下安全施行 RC。
