[Ranking of pelvic lymphadenectomy in therapy and prognosis of carcinoma of the bladder]. / Stellenwert der pelvinen Lymphadenektomie für Therapie und Prognose des Harnblasenkarzinoms.

ABSTRACT

PURPOSE: Due to the absence of internationally recognised guidelines on the necessary extent of lymphatic node removal in carcinoma of the bladder, we are still not sure as to which procedure is most favourable to therapeutic success. Hence, we checked retrospectively on the influence exercised by radical surgery on prognosis. MATERIAL AND METHOD: 506 patients were analysed retrospectively after radical cystectomy and pelvic lymphadenectomy with regard to the influence exercised on prognosis by clinical and histopathological variables. RESULTS: Statistically significant influential factors in univariate analysis were in the retrospective examination the pT category (p < 0.0001), lymphatic node status (p < 0.0001), grading (p = 0.0145), proof of uronephrosis (p = 0.0007), number of performed transurethral resections (p = 0.0043), surgeon (p = 0.0033) and number of resected lymph nodes (p = 0.0012). There was a significant difference between surgeons at a median number of 14.3 removed lymphatic nodes (range 1 - 46) in respect of radicality (p = 0.001) and prognosis (p < 0.0049). Independent influential factors in multivariate analysis were pT category (p = 0.003), pN category (p < 0.001) and the number of surgically removed lymphatic nodes (p = 0.038). CONCLUSION: In our retrospectively examined group of patients extensive lymphadenectomy significantly improved the prognosis and was thus a potentially curative procedure. Basing on these results, prospective studies will have to clarify the level of the standard applicable to pelvic lymphadenectomy and also the advantages and prospects of radical surgery in respect of possible patient survival.