Results of radical cystectomy and pelvic lymphadenectomy for bladder cancer with pelvic node metastases.

OBJECTIVES

To study the results on survival of radical cystectomy and pelvic lymphadenectomy in bladder cancer with pelvic node metastases in a retrospective study.

PATIENTS AND METHODS

Of 248 patients with transitional cell carcinoma of the bladder treated by cystectomy with pelvic lymphadenectomy from 1970 to 1990, 40 (16%; 37 males, 3 females) had pelvic nodal metastases. Fifteen patients had one positive lymph node (stage pN1) and 25 patients had more than one positive node (stage pN2). Preoperative pelvic radiotherapy was realized in 14 patients.

RESULTS

The perioperative mortality rate was 5% and the perioperative morbidity rate 15%. The overall 1- and 5-year survival rates for patients with nodal metastases were, respectively, 42 and 14%. Overall median survival was 9 months (range: 1-288 months). Three patients are still alive with follow-ups of 7, 12 and over 20 years. Kaplan-Meier survival curves revealed no survival advantage for stage pN1 over pN2 disease (p = 0.10). The 5-year survival rate for patients with stage pN1 was 22% with a median of survival of 17 months (range: 1-288 months). The 5-year survival rate for patients with pN2 disease was 8% with a median of survival of 7 months (range: 1-144 months). The cause of the death was tumoral progression in 26 patients (75%) and local recurrence in 3 patients (10%). A preoperative radiotherapy didn't influence survival.

CONCLUSION

In our experience, radical cystectomy with pelvic lymphadenectomy provided long-term progression-free survival for a few patients with nodal involvement. Efficacious adjuvant therapy has to be found to improve the results.