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Open Access 01-01-2020 | Cystectomy | Original Article

Association of super-extended lymphadenectomy at radical cystectomy with perioperative complications and re-hospitalization

Authors: David D’Andrea, Mohammad Abufaraj, Francesco Soria, Kilian Gust, Andrea Haitel, Pierre I. Krakiewicz, Shahrokh F. Shariat

Published in: World Journal of Urology | Issue 1/2020

Abstract

Purpose

We performed a retrospective analysis of patients treated with radical cystectomy and lymphadenectomy (LAD) for bladder cancer to assess the differential association of the extent of LAD with perioperative complications and re-hospitalization.

Materials and methods

LAD templates were defined as limited (lLAD = external, internal iliac and obturator), extended (eLAD = up to crossing of ureter and presacral lymph nodes), and super-extended (sLAD = up to the inferior mesenteric artery). Logistic regression models investigated the association of LAD templates with intraoperative, 30- and 30–90-day postoperative complications, as well as re-hospitalizations within 30 and 30–90 days.

Results

A total of 284 patients were available for analysis. sLAD led to a higher lymph-node yield (median 39 vs 13 for lLAD and 31 for eLAD, p < 0.05) and N2/N3 status compared to lLAD and eLAD (p = 0.04). sLAD was associated with a blood loss of > 500 ml (OR 1.3, 95% CI 1.08–1.49, p = 0.003) but not with intraoperative transfusion, operation time, or length of hospital stay (p > 0.05). Overall, 11 (4%) patients were readmitted within 30 days and 50 (17.6%) within 30–90 days. The 30- and 30–90-day mortality rates were 2.8% and 1.4%, respectively. On logistic regression, LAD template was not associated with postoperative complications or re-hospitalization rates.

Conclusions

sLAD leads to higher lymph-node yield and N2/N3 rate but not to higher complication rate compared to lLAD and eLAD. With the advent of novel adjuvant systemic therapies, precise nodal staging will have a crucial role in patients counseling and clinical decision making.

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Title: Association of super-extended lymphadenectomy at radical cystectomy with perioperative complications and re-hospitalization
Authors: David D’Andrea
Mohammad Abufaraj
Francesco Soria
Kilian Gust
Andrea Haitel
Pierre I. Krakiewicz
Shahrokh F. Shariat
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Cystectomy
Lymphadenectomy
Published in: World Journal of Urology / Issue 1/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02769-9

At a glance: The STEP trials

Springer Medicine

Association of super-extended lymphadenectomy at radical cystectomy with perioperative complications and re-hospitalization

Abstract

Purpose

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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