AB053. Laparoscopic pelvic lymph node dissection during radical cystectomy: strategy and clinical outcomes

OBJECTIVE: To discuss the effect of extended and standard laparoscopic pelvic lymph node dissection (PLND) during radical cystectomy, and to evaluate the benefit of dissecting lymph node before or after cystectomy. METHODS: From May, 2012 to June 2015, 47 patients with bladder urothelial carcinoma treated with laparoscopic radical cystectomy (LRC) with PLND, including 22 standard PLND and 25 extended PLND. 12 extended PLND were underwent before LRC, and 13 extended PLND were underwent after LRC. The complications, operative time and oncologic results were recorded and analyzed. RESULTS: For the 22 standard PLND, the operative time was (71.2±19.1) min and blood loss was (56.2±30.1) mL, with 1 lymphatic leakage (4.5%), no blood vessel injury. Follow-up 2 to 36 months, 1 case got local recurrence (4.5%), no distant metastasis. For the 25 extended PLND, the operative time was (95.1±30.5) min and blood loss was (59.1±32.3) mL, with 1 lymphatic leakage (4%) and 1 external iliac vein injury (4%). Follow-up 2 to 36 months, no patient got local recurrence or distant metastasis. The complications of the standard and extended PLND were no significant difference (P>0.05). But operative time of the extended PLND was much longer (P<0.05). The mean operative time of extended PLND before and after LRC was no significant difference [(96.4±33.5) vs. (94.7±29.2) min, P>0.05]. The mean number of harvested external iliac, obturator and retroperitoneal lymph nodes of extended PLND before and after LRC was no significant difference [(3.3±1.8) vs. (3.6±2.1), (5.2±1.2) vs. (5.3±1.2), (5.2±1.7) vs. (4.8±1.3), P>0.05]. CONCLUSIONS: Extended PLND got better pathologic and clinical outcomes, without more complications, but the operative time was much longer. So, extended PLND after LRC is easy to control total operative time,