RESUMEN
Patients undergoing radical prostatectomy at our hospital from January 1995 until March 2008 were subjected to limited lymphadenectomy involving only the obturator nerve lymph node. In contrast to published reports, of 488 biopsies, we encountered only three cases of lymph node metastasis. Therefore, starting in April 2008, we conducted a prospective study of limited versus extended lymphadenectomy, the latter involving the obturator fossa and internal iliac lymph nodes. One hundred patients undergoing radical prostatectomy from April 2008 until January 2010 were divided into two groups depending on whether they underwent extended lymphadenectomy (nï¼49) or limited lymphadenectomy (nï¼51). There were no significant differences in the patient background, estimated blood loss, or operation time between the two groups. Lymphnode metastases were not detected in either group. A significantly greater number of lymph nodes was obtained from the extended lymphadenectomy group (average 14.1) than from the limited lymphadenectomy group (average 8.3 ; pï¼0.01). Complications possibly attributable to lymphadenectomy included lymphocele in two patients in the limited group and one patient in the extended group. Extended lymphadenectomy was determined to be a safe procedure that provides the pathologist with a large sample size. None of the patients in either group harbored a detectable lymph node metastasis.
Asunto(s)
Escisión del Ganglio Linfático/métodos , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Anciano , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVES: To determine the pathological features and clinical course of intravesical recurrence after nephroureterectomy (NU) for upper urinary tract (UUT) cancer. PATIENTS AND METHODS: Among 325 patients undergoing NU with bladder cuff excision for UUT cancer, in this retrospective multi-institutional study we evaluated 113 who developed bladder tumour after NU. Excluding patients with (i) perioperative systemic chemotherapy or radiotherapy for UUT cancer; (ii) a history of previous or synchronous bladder cancer at the time of NU; (iii) distant metastasis at the time of NU; (iv) a follow-up of <1 year after the initial bladder cancer recurrence; or (v) missing data, 74 patients were included in this study. We compared the pathology between UUT cancer and the first bladder cancer recurrence, using Fisher's exact test. Further intravesical recurrence and bladder cancer progression was analysed using the Kaplan-Meier method, with the log-rank test used to assess significance. A Cox proportional hazard model was used for multivariate analysis. RESULTS: The grade of the first bladder cancer recurrence strongly correlated with that of the UUT tumour (P < 0.001) and the carcinoma in situ (CIS) lesion with the first bladder cancer recurrence correlated with high grade (grade 3) UUT tumour (P < 0.001). In all, 56 of the assessable 70 patients further developed intravesical recurrence at a median interval of 7 months after the first bladder cancer recurrence. There were no clinicopathological factors that predicted the second recurrence. Progression occurred in 14 patients, at a median interval of 25 months. A CIS lesion with the first bladder cancer recurrence was a risk factor for progression on multivariate analysis. CONCLUSIONS: A large proportion of the patients who developed bladder tumour after NU had further intravesical recurrence, which indicated its refractory nature. Especially when a CIS lesion is detected in the initial intravesical recurrence, a careful follow-up is mandatory to detect bladder cancer progression.
Asunto(s)
Neoplasias Renales/cirugía , Neoplasias Primarias Secundarias/patología , Nefrectomía/métodos , Uréter/cirugía , Neoplasias Ureterales/cirugía , Neoplasias de la Vejiga Urinaria/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma in Situ/patología , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/patología , Estudios RetrospectivosRESUMEN
OBJECTIVES: To evaluate the prognostic role of different clinico-pathological parameters in node-positive patients treated by radical cystectomy. METHODS: A retrospective multi-institutional study of 435 patients who underwent radical cystectomy between 1990 and 2005 was carried out. Of them, pathological lymph node (LN) metastases were found in 83 patients. Sixty of these 83 patients, whose clinical information and follow-up data were available, were included in the analysis. Twenty-five patients had undergone adjuvant chemotherapy, whereas 35 had not. A Cox proportional hazards model was used to determine the impact of the following clinico-pathological parameters on patient survival: number of resected LNs, number of positive LNs, LN density (defined as the ratio of the number of positive LNs divided by the total number of resected LNs) and adjuvant chemotherapy. RESULTS: Median follow-up for surviving patients was 41 months (range 4-138) after surgery. The median survival time for all patients was 22 months (95% confidence interval, 15-42 months). At multivariate analysis, LN density of 25% or less, adjuvant chemotherapy and pure urothelial carcinoma were independently significant predictors of survival. CONCLUSIONS: Lymph node density predicts survival in patients with node-positive bladder cancer.
Asunto(s)
Carcinoma de Células Transicionales/mortalidad , Carcinoma de Células Transicionales/terapia , Cistectomía/métodos , Ganglios Linfáticos/patología , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Transicionales/secundario , Quimioterapia Adyuvante , Estudios de Cohortes , Terapia Combinada , Intervalos de Confianza , Femenino , Humanos , Inmunohistoquímica , Japón , Estimación de Kaplan-Meier , Escisión del Ganglio Linfático/métodos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Probabilidad , Pronóstico , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
OBJECTIVES: To determine the role of lymph-node (LN) dissection in patients undergoing surgery for upper urinary tract (UUT) cancer. PATIENTS AND METHODS: We reviewed the clinicopathological data from 312 patients with UUT cancer treated predominantly by nephroureterectomy. The relationship between clinical characteristics and cancer-specific survival (CSS) was analysed, focusing on node-related information. RESULTS: In all, 166 patients had LN dissection while 146 did not (pNx). Multivariate analysis showed that T stage, grade and pN status were significant variables for CSS. The difference in survival between the pN0 and pNx groups remained significant in a multivariate analysis. The median (range) number of LNs removed was 6 (1-65). There was no significant difference in CSS between the 72 patients with fewer than six LNs removed and the 78 with six or more removed. CONCLUSIONS: LN dissection is important for postoperative stratification of patients with UUT cancer because node-positive disease was one of the variables with a significant adverse effect on survival. In addition, the significant difference in survival between the pN0 and pNx groups might indicate a therapeutic benefit of LN dissection, although removing more LNs did not uniformly increase the probability of CSS.