Role of Pelvic Lymph Node Dissection (PLND) for High Risk Bladder Cancer by Dr. Bochner скачать в хорошем качестве

Role of Pelvic Lymph Node Dissection (PLND) for High Risk Bladder Cancer by Dr. Bochner

Bernard H. Bochner, MD, FACS, Urologic Surgeon, Memorial Sloan Kettering Cancer Center, New York, New York, examines the extent of lymph node dissection in bladder cancer surgery and its impact on oncologic outcomes. In this 14-minute presentation, he addresses pelvic lymph node involvement in invasive bladder cancer; historical data suggest that about one-third of patients with node-positive disease achieve long-term survival following surgery alone. Dr. Bochner debates whether extending the lymph node dissection above the common iliac bifurcation to the aortic bifurcation improves outcomes. A German trial demonstrated a 5% improvement in recurrence-free survival with extended dissection. However, the SWOG S1011 trial excluded patients with radiographically evident N3 disease and found no benefit. Morbidity rates varied, with the German study showing no increased complications, whereas SWOG reported a significant rise in major surgical toxicities. The findings suggest that extended lymph node dissection may benefit high-risk patients but remains controversial due to study limitations and selection biases. Dr. Bochner believes that standardization of surgical approaches and further trials are needed to clarify the role of extended lymphadenectomy in bladder cancer management.