Lymphadenectomy before and after radical cystectomy: does this affect the radicality? A prospective randomized comparative study

• Published in: International urology and nephrology 2024-03, Vol.56 (3), p.965-972
• Main Authors: Moeen, Ahmed M., Hameed, Diaa A., Mostafa, Mohamed G., Shaban, Shimaa H.
• Format: Article
• Language: English
• Subjects: Abdomen; Bladder cancer; Chemotherapy; Complications; Cystectomy - adverse effects; Dissection; Humans; Laboratories; Lymph Node Excision - adverse effects; Lymphatic system; Magnetic resonance imaging; Medicine; Medicine & Public Health; Morbidity; Nephrology; Patients; Postoperative; Prospective Studies; Retrospective Studies; Statistical analysis; Treatment Outcome; Urinary Bladder Neoplasms - surgery; Urinary Diversion; Urogenital system; Urological surgery; Urology; Urology - Original Paper
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-023-03826-4

Purpose To compare the oncological outcome of performing ePLND before or after RC in 200 patients in a prospective randomized manner. Materials and methods From January 2014 to December 2019, 200 patients with T2-T3b N0M0 BCa were included in the current study after signing an informed consent. Patients were divided into two groups, 100 in each one. Group I underwent ePLND before RC, whereas group II underwent ePLND after RC. Postoperative evaluation included clinical, laboratory, and radiographic studies. Results Patients’ characteristics were comparable between both groups. The mean operative time excluding that of urinary diversion was significantly shorter in group II than in group I ( p  = 0.01). The mean number of LNs removed was 25 ± 6 in group I and 32 ± 8 in group II ( p  = 0.141). Intraoperative complications occurred in four patients in the form of external iliac artery and vein injury [two in each group ( p  = 0. 245)]. Postoperative complications were comparable between both groups with no statistically significant difference ( p  = 0.375). Oncological failure occurred in 28 patients [16 (17.6%) in group I and 12 (22%) in group II ( p  = 0.389)]. Conclusions EPLND before and after RC has comparable oncological outcomes. The stage of the disease, the time since the first diagnosis till RC and the surgeon experience in performing meticulous ePLND are more important. In absence of oncological superiority, the timing of ePLND should be judged according to the patient-related factors to facilitate safe RC with minimal morbidity.