Lymphadenectomy for Bladder Cancer at the Time of Radical Cystectomy
A partir d'une revue systématique de la littérature publiée entre 1998 et 2012, cet article fait le point sur les données probantes concernant l'intérêt d'une lymphadénectomie durant une cystectomie radicale pour améliorer la survie des patients atteints d'un cancer de la vessie
Context : Although the importance of lymphadenectomy during radical cystectomy (RC) in high-risk non–muscle-invasive and muscle-invasive bladder cancer (BCa) is well accepted, the optimal extent of lymphadenectomy, number of lymph nodes (LNs) to be retrieved, and prognostic and therapeutic role of lymphadenectomy remain debated issues. Objective : In this review, we summarize the existing data on the value of lymphadenectomy for staging and outcome of BCa patients undergoing RC and lymphadenectomy. Evidence acquisition : A systematic Medline/PubMed literature search of peer-reviewed scientific articles published from 1998 and 2012, concerning the role of lymphadenectomy in BCa patients, was carried out. The terms and permutations used were lymphadenectomy, bladder cancer/carcinoma, urothelial carcinomas, radical cystectomy, lymph node metastasis, lymph node dissection, bladder, recurrence, and survival. Selective older articles were included. Evidence synthesis : Bilateral pelvic lymphadenectomy is an integral part of RC for BCa. The literature regarding the role of lymphadenectomy in BCa patients in general is retrospective, nonstandardized, and of low-level quality in regard to evidence. Prospective randomized trials designed to define the optimal template of lymphadenectomy and its impact on oncologic outcome are advocated. Some of these studies are ongoing, and their completion and analyses are necessary to resolve controversies. Conclusions : Many consistent and concordant observations, although of low level of evidence, document that the extent of lymphadenectomy may influence disease-free survival after RC independent of the status of LNs and the pathologic stage of BCa. Lymphadenectomy standardization at the time of RC to create evidence-based guidelines is essential for further improvement of surgical quality and BCa patient survival. Take Home Message : Removal of regional lymph nodes at radical cystectomy is important to optimize disease-specific outcomes in patients with bladder cancer. The necessary extent of lymph node dissection remains controversial. Evidence-based guidelines will require high-level data from future prospective studies.