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首页> 外文期刊>Nature reviews. Urology >Pelvic lymph node dissection during radical cystectomy for muscle-invasive bladder cancer.
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Pelvic lymph node dissection during radical cystectomy for muscle-invasive bladder cancer.

机译：骨盆膀胱切除术期间盆腔淋巴结解剖。

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摘要

Radical cystectomy is the gold-standard treatment option for muscle-invasive and metastatic bladder cancer. At the time of cystectomy, up to 25% of patients harbour metastatic lymph node deposits. These deposits most frequently occur in the obturator fossa, but can be as proximal as the interaortocaval region. Thus, the use of concurrent pelvic lymph node dissection (PLND) with cystectomy has been increasingly reported. Data from studies including many patients suggest substantial oncological benefit in PLND cohorts versus non-PLND cohorts, irrespective of pathological nodal status. Additionally, PLND provides useful prognostic information, including disease burden, lymph node density, and extracapsular extension of metastatic lymph nodes. Accordingly, the National Comprehensive Cancer Network guidelines advocate the use of PLND during radical cystectomy for muscle-invasive bladder cancer. Despite this recommendation, a lack of consensus exists regarding the optimal PLND template. Comparative series suggest that extended PLND provides improved recurrence-free survival and cancer-specific survival compared with more limited PLND templates. More extensive templates (such as super-extended PLND) provide no additional survival benefit at the potential cost of increased operative time and patient morbidity. In addition to extended PLND templates, increased nodal harvest confers an oncological benefit in patients with node-positive disease or in patients with node-negative disease. Accordingly, recommendations for a minimum nodal yield have been proposed. Despite the growing body of evidence, formal recommendations by oncological and urological authoritative bodies have been limited owing to the lack of randomized data and level I evidence.
机译：自由基膀胱切除术是肌肉侵入性和转移性膀胱癌的金标准治疗选择。在膀胱切除术时，高达25％的患者患者患有转移性淋巴结沉积物。这些沉积物最常发生在闭塞器窝中，但可以像间断区域区域一样近端。因此，越来越多地报道了使用膀胱切除术的同时盆腔淋巴结夹层（PLND）。来自包括许多患者的研究的数据表明PLND队列与非PLND队列的大量肿瘤效益，无论病原学节点状况如何。此外，PLND提供有用的预后信息，包括疾病负担，淋巴结密度和转移性淋巴结的折叠延伸。因此，全国综合癌症网络指南倡导在激进膀胱切除术期间使用PLND用于肌肉侵入性膀胱癌。尽管有这项建议，但有关最佳PLND模板的缺乏共识。比较系列表明，与更多有限的PLND模板相比，扩展PLND提供了可改善的无复发存活和癌症特异性的存活。更广泛的模板（如超级扩展PLND）不提供额外的存活益处，潜在的效率效益增加，持续的操作时间和患者发病率。除了扩展的PLND模板外，还增加了节点阳性疾病患者的核心收获，或者在节点阴性疾病患者中赋予了肿瘤学好益处。因此，已经提出了最低结果的建议。尽管存在越来越多的证据，但由于缺乏随机数据和我的证据，肿瘤和泌尿外主权机构的正式建议是有限的。

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  • 来源
    《Nature reviews. Urology》 |2018年第11期|共7页
  • 作者

    Marlon Perera; Shannon McGrath; Shomik Sengupta; Jack Crozier; Damien Bolton; Nathan Lawrentschuk;

  • 作者单位

    Department of Surgery Austin Health University of Melbourne Melbourne Victoria Australia;

    Department of Surgery Austin Health University of Melbourne Melbourne Victoria Australia;

    Department of Surgery Austin Health University of Melbourne Melbourne Victoria Australia;

    Department of Surgery Austin Health University of Melbourne Melbourne Victoria Australia;

    Department of Surgery Austin Health University of Melbourne Melbourne Victoria Australia;

    Department of Surgery Austin Health University of Melbourne Melbourne Victoria Australia;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 泌尿科学（泌尿生殖系疾病）;
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