Clinical Significance Of Radical Cystectomy With Extended Lymphadenectomy And Influencing Factors Associated With Recurrence Of Bladder Cancer

Objective:To compare the prognosis of patients with extended lymphadenectomy versusstandard lymphadenectomy at radical cystectomy (RC).Methods:A retrospective analysis was done of75cases with bladder cancer who receivedradical cystectomy from March2008to July2012in the NanChang University FirstHospital. The patients did not receive any neoadjuvant or adjuvant therapy.To findthe main factors relating to prognosis through multiple-factor analysis.Results:Of the75patients,33received extended lymphadenectomy and the other42underwent standard lymphadenectomy. The6、12、18、24months disease-freesurvival in the extended lymphadenectomy group were93%、89%、84%、77%respectively. In the standard lymphadenectomy the corresponding figures were85%、76%、62%、59%respectively.(P=0.081). When restricting the analyses to lymphnode–positive patients, patients with extended lymphadenectomy had much betterdisease-free survival compared with patients with standard lymphadenectomy(P=0.048). Among the patients after February2010，The average number of lymphnode removed in the extended lymphadenectomy group were20.30±6.66comparedwith13.95±6.49in the standard lymphadenectomy (P<0.05). There’s no statisticalsignificance between two group’s mean operation time、blood loss amount and theincidence rate of complications (P>0.05). By bringing the age、sex、pT stage、pathological grade、extent of lymph node resection、number of lymph node removed、lymph node metastasis、 intraoperative transfusion and urinary diversion asconcomitant variable into the regression analysis model. The main factors forprognosis was established. Extent of lymph node resection, pT stage, pathologicalgrade and lymph node metastasis had independent influences on DFS in every Coxregression model. In the ePLND group，as much as17.78percent of the positive lymph nodes located outside the extent of sPLND，There are50%patients withmetastasis over the level of common iliac artery.Conclusions:1. Extended lymphadenectomy is associated with better disease-free survivalfor lymph node–positive patients who underwent radical cystectomy.2. The ePLND do not contribute significantly to the operative time,intraoperative bleeding and postoperative complications.3. The extent of lymph node resection is a important prognostic factor forbladder cancer after operation.4. The ePLND can expand the excision extension of positive lymph nodes...