1981 QUALITY OF LYMPHADENECTOMY IS EQUIVALENT IN ROBOTIC AND OPEN CYSTECTOMY USING AN EXTENDED TEMPLATEстатья из журнала
Аннотация: You have accessJournal of UrologyBladder Cancer: Metastatic Disease1 Apr 20111981 QUALITY OF LYMPHADENECTOMY IS EQUIVALENT IN ROBOTIC AND OPEN CYSTECTOMY USING AN EXTENDED TEMPLATE Ronney Abaza, Kamal Pohar, and Robert Bahnson Ronney AbazaRonney Abaza Columbus, OH More articles by this author , Kamal PoharKamal Pohar Columbus, OH More articles by this author , and Robert BahnsonRobert Bahnson Columbus, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2207AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Relative to lesser templates, extended lymph node dissection (eLND) more accurately assigns nodal stage, removes more positive lymph nodes, and may have greater survival benefit. Minimally-invasive techniques for radical cystectomy have been criticized due to concerns over ability to adequately perform eLND. We determined whether the quality of lymphadenectomy in robotic and open cystectomy is comparable using an extended template by assessing node yield and positivity. METHODS Extended lymph node dissection (eLND) was performed in 120 open and 35 robotic cystectomy patients by a dedicated open or dedicated robotic surgeon. Extended lymphadenectomy was strictly defined as thorough skeletonization of anatomical structures in each nodal group below the aortic bifurcation, including common iliac, external iliac, obturator, hypogastric, and presacral node chains. The hypogastric nodes included skeletonization of the triangle of Marcille (presciatic space). Lymph nodes were identified by palpation without fat clearing techniques or solvents. Nodes from robotic cases were extracted and submitted en bloc or as a maximum of two specimens while open surgery allowed nodes to be submitted as packets from each of the 5 nodal basins. RESULTS The mean lymph node count in the open group was 36.9 ± 14.8 (range, 11 to 87). Only 12 of 120 patients (10%) had a total node count of less than 20. In the robotic group, the mean node yield was 37.5 ± 13.2 (range, 18 to 64) with only 2 of 35 patients (6%) having less than 20 nodes. In the open group, 36 patients (30%) had lymph node metastasis, and in the robotic group, 11 patients (31%) had involved nodes. Open eLND identified 80% and 90% confidence of accurate staging as pN0 when 23 and 27 nodes were obtained, respectively. A total lymph node count of 23 or 27 was achieved in 104 (87%) and 92 (77%) of the open surgery patients and in 32 (91%) and 29 (83%) patients who had robotic surgery. Among open surgical patients, 36% of patients received neoadjuvant chemotherapy as compared with 31% in the robotic surgery group. CONCLUSIONS No difference was identified in the total number of lymph nodes removed and the number of node-positive patients when comparing open and robotic cystectomy with extended lymphadenectomy. Local recurrence and disease specific survival data will be required to confirm whether the two techniques are oncologically equivalent. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e793 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ronney Abaza Columbus, OH More articles by this author Kamal Pohar Columbus, OH More articles by this author Robert Bahnson Columbus, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Год издания: 2011
Авторы: Ronney Abaza, Kamal S. Pohar, Robert Bahnson
Издательство: Lippincott Williams & Wilkins
Источник: The Journal of Urology
Ключевые слова: Bladder and Urothelial Cancer Treatments, Tissue Engineering and Regenerative Medicine, Ureteral procedures and complications
Открытый доступ: closed
Том: 185
Выпуск: 4S