Anatomical Extent of Pelvic Lymphadenectomy in Bladder and Prostate Cancer

In bladder cancer, pelvic lymphadenectomy as a common procedure of radical cystectomy has not been standardized although evidence supports a relationship between the extent of lymph node dissection and therapeutic outcome. Recent retrospective and prospective clinical trials have carefully analysed the distribution of lymph node metastases at time of radical cystectomy thereby identifying those regions which should be included in a standard pelvic lymph node dissection. Dissecting all lymphatic tissue along the common iliac region with the aortic bifurcation as cranial margin, along the external, internal iliac region and the obturator fossa bilaterally will completely clear 80% of all positive nodes. Only if frozen section examination will demonstrate micrometastases at these regions, extending lymphadenectomy further cranially will be worthwile. Currently, epLA in bladder cancer has been shown to improve progression-free survival if >14 lymph nodes are removed. For the future, prospective trials have to demonstrate a benefit with regard to cancer specific and overall survival and in terms of regional versus distant recurrences.