【正文】 ng Therapeutic benefits Absolute limits of dissection unknown ? 第四十八頁，共八十七頁。 USC/ NORRIS BLADDER CANCER EXPERIENCE (6/7112/97) 第四十頁，共八十七頁。 USC/Norris Lymph Node Positive Bladder Cancer Experience Morbidity and Mortality ? 2 perioperative deaths (1%) ? 66 early plications (27%) ? No plication directly related to PLND 0 5 10 15 20 25 30 % Morbidity Mortality 第三十二頁，共八十七頁。 Genitofemoral nerve Pelvic Iliac Lymphadenectomy Level of the inferior mesenteric artery Genitofemoral nerveLymph node of Cloquet * 第二十四頁，共八十七頁。 Lymph Node Positive Bladder Cancer Lymph Node Density ? Novel concept ? of involved LN / of LN removed ? Accounts for: 1. LN tumor burden 2. Extent of PLND 第十七頁，共八十七頁。 USC Radical Cystectomy Experience: LongTerm Results in 1,054 Patients J. Clin. Oncol., 19: 666, 2024. ? Radical cystectomy with BPLND ? 24% of patients LN+ disease ? Risk factors include: ? pstage ? of LN involved 第九頁，共八十七頁。The Role of Lymphadenectomy in Bladder Cancer John P. Stein, . University of Southern California Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles CA 第一頁，共八十七頁。 Risk Factors for Lymph Node Metastases Following Radical Cystectomy: The Concept of Lymph Node Density John P. Stein, . University of Southern California Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles CA 第八頁，共八十七頁。 Radical Cystectomy Extent of Lymphadenectomy ? Prognostic factors in LN disease: ? Herr et al, J Urol, 167 1298, 2024 ? Poulsen et al, J Urol, 160, 2024, 2024 ? Leissner et al, Br J Urol, 85, 817, 2024 第十六頁，共八十七頁。 Genitofemoral nerve Pelvic Iliac Lymphadenectomy Level of the inferior mesenteric artery 第二十三頁，共八十七頁。 USC/Norris Lymph Node Positive Bladder Cancer Experience Lymph Nodes ? Median of LN removed: 30 (range 196) ? Median of LN involved: 2 (range 163) 30 2 第三十一頁，共八十七頁。 USC/ NORRIS BLADDER CANCER EXPERIENCE (6/7112/97) 第三十九頁，共八十七頁。 Prognostic Factors in LN(+) Bladder Ca Multivariable Analysis RecurrenceFree Survival Prognostic Factors RR pValue Pathologic Subgroup (EV vs. OC) Adjuvant Chemotherapy (Yes vs. No) Lymph Node Density (20% vs. ≤20%) Lymph Nodes Involved (8 vs. ≤8) 第四十七頁，共八十七頁。 Extended Lymphadenectomy: Multicenter Prospective Trial Leissner et al., J. Urol., 171: 139, 2024. ? Extended dissection takes 60 minutes longer ? No increase in morbidity or mortality ? For unilateral bladder tumors contralateral nodal metastases monly occurred ? Lymph nodes + at level III only do not occur ? Lymph nodes + at level II only in 7% ? Lymph nodes + at level III occur in 13% and presacral in 6% of all nodepositive patients ? “Strongly remend an extended bilateral LND in all patients undergoing cystectomy〞 第五十五頁，共八十七頁。 USC BLADDER CANCER EXPERIENCE RADICAL CYSTECTOMY Conclusions ? Best survival results ? Low local (pelvic) recurrence (7%) ? Lowest incidence of developing metastatic or progressive disease (29%) 第六十三頁，共八十七頁。 BLADDER CANCER: INDICATIONS FOR RADICAL CYSTECTOMY ? Muscle invasive tumor ? High grade tumor with cis 第七十一頁，共八十七頁。 PelvicIliac Lymphadectomy 第七十九頁，共八十七頁。 內(nèi)容總結(jié) The Role of Lymphadenectomy in Bladder Cancer