The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer

A Systematic Review

Harman M Bruins, Erik Veskimae, Virginia Hernandez, Mari Imamura, Molly M Neuberger, Philip Dahm, Fiona Stewart, Thomas B Lam, James N'Dow, Antoine G van der Heijden, Eva Compérat, Nigel C Cowan, Maria De Santis, Georgios Gakis, Thierry Lebret, Maria J Ribal, Amir Sherif, J Alfred Witjes

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Abstract

CONTEXT: Controversy exists regarding the therapeutic value of lymphadenectomy (LND) in patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).

OBJECTIVE: To systematically review the relevant literature assessing the impact of LND on oncologic and perioperative outcomes in patients undergoing RC for MIBC.

EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, the Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Center on Health Sciences Information (LILACS) were searched up to December 2013. Comparative studies reporting on no LND, limited LND (L-LND), standard LND (S-LND), extended LND (E-LND), superextended LND (SE-LND), and oncologic and perioperative outcomes were included. Risk-of-bias and confounding assessments were performed.

EVIDENCE SYNTHESIS: Twenty-three studies reporting on 19 793 patients were included. All but one study were retrospective. Planned meta-analyses were not possible because of study heterogeneity; therefore, data were synthesized narratively. There were high risks of bias and confounding across most studies as well as extreme heterogeneity in the definition of the anatomic boundaries of LND templates. All seven studies comparing LND with no LND favored LND in terms of better oncologic outcomes. Seven of 14 studies comparing (super)extended LND with L-LND or S-LND reported a beneficial outcome for (super)extended LND in at least a subset of patients. No difference in outcome was reported in two studies comparing E-LND and S-LND. The comparative harms of different extents of LND remain unclear.

CONCLUSIONS: Although the quality of the data was poor, the available evidence indicates that any kind of LND is advantageous over no LND. Similarly, E-LND appears to be superior to lesser degrees of dissection, while SE-LND offered no additional benefits. It is hoped that data from ongoing randomized clinical trials will clarify remaining uncertainties.

PATIENT SUMMARY: The current literature suggests that removal of lymph nodes in bladder cancer surgery is beneficial and might result in better outcomes in terms of prolonging survival; however, the quality of the available studies is poor, and high-quality studies are needed.

Original languageEnglish
Pages (from-to)1065-1077
Number of pages13
JournalEuropean Urology
Volume66
Issue number6
Early online date26 Jul 2014
DOIs
Publication statusPublished - Dec 2014

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Cystectomy
Lymph Node Excision
Urinary Bladder Neoplasms
Information Science
Muscles
Uncertainty
Meta-Analysis
Dissection
Randomized Controlled Trials
Retrospective Studies
Lymph Nodes
Survival
Health
Therapeutics

Keywords

  • bladder neoplasms
  • radical cystectomy
  • lymphadenectomy
  • lymph node dissection
  • standard
  • extended dissection
  • superextended dissection
  • oncologic outcomes

Cite this

The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer : A Systematic Review. / Bruins, Harman M; Veskimae, Erik; Hernandez, Virginia; Imamura, Mari; Neuberger, Molly M; Dahm, Philip; Stewart, Fiona; Lam, Thomas B; N'Dow, James; van der Heijden, Antoine G; Compérat, Eva; Cowan, Nigel C; De Santis, Maria; Gakis, Georgios; Lebret, Thierry; Ribal, Maria J; Sherif, Amir; Witjes, J Alfred.

In: European Urology, Vol. 66, No. 6, 12.2014, p. 1065-1077.

Research output: Contribution to journalArticle

Bruins, HM, Veskimae, E, Hernandez, V, Imamura, M, Neuberger, MM, Dahm, P, Stewart, F, Lam, TB, N'Dow, J, van der Heijden, AG, Compérat, E, Cowan, NC, De Santis, M, Gakis, G, Lebret, T, Ribal, MJ, Sherif, A & Witjes, JA 2014, 'The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Systematic Review', European Urology, vol. 66, no. 6, pp. 1065-1077. https://doi.org/10.1016/j.eururo.2014.05.031
Bruins, Harman M ; Veskimae, Erik ; Hernandez, Virginia ; Imamura, Mari ; Neuberger, Molly M ; Dahm, Philip ; Stewart, Fiona ; Lam, Thomas B ; N'Dow, James ; van der Heijden, Antoine G ; Compérat, Eva ; Cowan, Nigel C ; De Santis, Maria ; Gakis, Georgios ; Lebret, Thierry ; Ribal, Maria J ; Sherif, Amir ; Witjes, J Alfred. / The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer : A Systematic Review. In: European Urology. 2014 ; Vol. 66, No. 6. pp. 1065-1077.
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abstract = "CONTEXT: Controversy exists regarding the therapeutic value of lymphadenectomy (LND) in patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).OBJECTIVE: To systematically review the relevant literature assessing the impact of LND on oncologic and perioperative outcomes in patients undergoing RC for MIBC.EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, the Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Center on Health Sciences Information (LILACS) were searched up to December 2013. Comparative studies reporting on no LND, limited LND (L-LND), standard LND (S-LND), extended LND (E-LND), superextended LND (SE-LND), and oncologic and perioperative outcomes were included. Risk-of-bias and confounding assessments were performed.EVIDENCE SYNTHESIS: Twenty-three studies reporting on 19 793 patients were included. All but one study were retrospective. Planned meta-analyses were not possible because of study heterogeneity; therefore, data were synthesized narratively. There were high risks of bias and confounding across most studies as well as extreme heterogeneity in the definition of the anatomic boundaries of LND templates. All seven studies comparing LND with no LND favored LND in terms of better oncologic outcomes. Seven of 14 studies comparing (super)extended LND with L-LND or S-LND reported a beneficial outcome for (super)extended LND in at least a subset of patients. No difference in outcome was reported in two studies comparing E-LND and S-LND. The comparative harms of different extents of LND remain unclear.CONCLUSIONS: Although the quality of the data was poor, the available evidence indicates that any kind of LND is advantageous over no LND. Similarly, E-LND appears to be superior to lesser degrees of dissection, while SE-LND offered no additional benefits. It is hoped that data from ongoing randomized clinical trials will clarify remaining uncertainties.PATIENT SUMMARY: The current literature suggests that removal of lymph nodes in bladder cancer surgery is beneficial and might result in better outcomes in terms of prolonging survival; however, the quality of the available studies is poor, and high-quality studies are needed.",
keywords = "bladder neoplasms, radical cystectomy, lymphadenectomy, lymph node dissection, standard, extended dissection, superextended dissection, oncologic outcomes",
author = "Bruins, {Harman M} and Erik Veskimae and Virginia Hernandez and Mari Imamura and Neuberger, {Molly M} and Philip Dahm and Fiona Stewart and Lam, {Thomas B} and James N'Dow and {van der Heijden}, {Antoine G} and Eva Comp{\'e}rat and Cowan, {Nigel C} and {De Santis}, Maria and Georgios Gakis and Thierry Lebret and Ribal, {Maria J} and Amir Sherif and Witjes, {J Alfred}",
note = "Copyright {\circledC} 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.",
year = "2014",
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TY - JOUR

T1 - The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer

T2 - A Systematic Review

AU - Bruins, Harman M

AU - Veskimae, Erik

AU - Hernandez, Virginia

AU - Imamura, Mari

AU - Neuberger, Molly M

AU - Dahm, Philip

AU - Stewart, Fiona

AU - Lam, Thomas B

AU - N'Dow, James

AU - van der Heijden, Antoine G

AU - Compérat, Eva

AU - Cowan, Nigel C

AU - De Santis, Maria

AU - Gakis, Georgios

AU - Lebret, Thierry

AU - Ribal, Maria J

AU - Sherif, Amir

AU - Witjes, J Alfred

N1 - Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2014/12

Y1 - 2014/12

N2 - CONTEXT: Controversy exists regarding the therapeutic value of lymphadenectomy (LND) in patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).OBJECTIVE: To systematically review the relevant literature assessing the impact of LND on oncologic and perioperative outcomes in patients undergoing RC for MIBC.EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, the Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Center on Health Sciences Information (LILACS) were searched up to December 2013. Comparative studies reporting on no LND, limited LND (L-LND), standard LND (S-LND), extended LND (E-LND), superextended LND (SE-LND), and oncologic and perioperative outcomes were included. Risk-of-bias and confounding assessments were performed.EVIDENCE SYNTHESIS: Twenty-three studies reporting on 19 793 patients were included. All but one study were retrospective. Planned meta-analyses were not possible because of study heterogeneity; therefore, data were synthesized narratively. There were high risks of bias and confounding across most studies as well as extreme heterogeneity in the definition of the anatomic boundaries of LND templates. All seven studies comparing LND with no LND favored LND in terms of better oncologic outcomes. Seven of 14 studies comparing (super)extended LND with L-LND or S-LND reported a beneficial outcome for (super)extended LND in at least a subset of patients. No difference in outcome was reported in two studies comparing E-LND and S-LND. The comparative harms of different extents of LND remain unclear.CONCLUSIONS: Although the quality of the data was poor, the available evidence indicates that any kind of LND is advantageous over no LND. Similarly, E-LND appears to be superior to lesser degrees of dissection, while SE-LND offered no additional benefits. It is hoped that data from ongoing randomized clinical trials will clarify remaining uncertainties.PATIENT SUMMARY: The current literature suggests that removal of lymph nodes in bladder cancer surgery is beneficial and might result in better outcomes in terms of prolonging survival; however, the quality of the available studies is poor, and high-quality studies are needed.

AB - CONTEXT: Controversy exists regarding the therapeutic value of lymphadenectomy (LND) in patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).OBJECTIVE: To systematically review the relevant literature assessing the impact of LND on oncologic and perioperative outcomes in patients undergoing RC for MIBC.EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, the Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Center on Health Sciences Information (LILACS) were searched up to December 2013. Comparative studies reporting on no LND, limited LND (L-LND), standard LND (S-LND), extended LND (E-LND), superextended LND (SE-LND), and oncologic and perioperative outcomes were included. Risk-of-bias and confounding assessments were performed.EVIDENCE SYNTHESIS: Twenty-three studies reporting on 19 793 patients were included. All but one study were retrospective. Planned meta-analyses were not possible because of study heterogeneity; therefore, data were synthesized narratively. There were high risks of bias and confounding across most studies as well as extreme heterogeneity in the definition of the anatomic boundaries of LND templates. All seven studies comparing LND with no LND favored LND in terms of better oncologic outcomes. Seven of 14 studies comparing (super)extended LND with L-LND or S-LND reported a beneficial outcome for (super)extended LND in at least a subset of patients. No difference in outcome was reported in two studies comparing E-LND and S-LND. The comparative harms of different extents of LND remain unclear.CONCLUSIONS: Although the quality of the data was poor, the available evidence indicates that any kind of LND is advantageous over no LND. Similarly, E-LND appears to be superior to lesser degrees of dissection, while SE-LND offered no additional benefits. It is hoped that data from ongoing randomized clinical trials will clarify remaining uncertainties.PATIENT SUMMARY: The current literature suggests that removal of lymph nodes in bladder cancer surgery is beneficial and might result in better outcomes in terms of prolonging survival; however, the quality of the available studies is poor, and high-quality studies are needed.

KW - bladder neoplasms

KW - radical cystectomy

KW - lymphadenectomy

KW - lymph node dissection

KW - standard

KW - extended dissection

KW - superextended dissection

KW - oncologic outcomes

U2 - 10.1016/j.eururo.2014.05.031

DO - 10.1016/j.eururo.2014.05.031

M3 - Article

VL - 66

SP - 1065

EP - 1077

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 6

ER -