Extended Pelvic Lymph Node Dissection: Before or after Radical Cystectomy? A Multicenter Study of the Turkish Society of Urooncology

PURPOSE We aimed to ascertain the effects of performing extended pelvic lymph node dissection (PLND) on the duration of surgery, morbidity, and the number of lymph nodes removed when the dissection was performed before or after radical cystectomy (RC). MATERIALS AND METHODS We used the database of our previous prospective multicenter study. A total of 118 patients underwent RC and extended PLND. Of the 118 patients, 48 (40.7%) underwent extended PLND before RC (group 1) and 70 (59.3%) underwent extended PLND after RC (group 2). The two groups were compared for extended PLND time, RC time, and total operation times, per operative morbidity, and the total numbers of lymph nodes removed. RESULTS Clinical and pathologic characteristics were comparable in the two groups (p>0.05). The mean RC time and mean total operation times were significantly shorter in group 1 than in group 2 (p<0.001). The mean number of lymph nodes removed was 27.31±10.36 in group 1 and 30.87±8.3 in group 2 (p=0.041). Only at the presacral region was the mean number of lymph nodes removed significantly fewer in group 1 than in group 2 (p=0.001). Intraoperative and postoperative complications and drain withdrawal time were similar in both groups (p=0.058, p=0.391, p=0.613, respectively). CONCLUSIONS When extended PLND was performed before RC, the duration of RC and consequently the total duration of the operation were significantly shorter than when extended PLND was performed after RC. Practitioners may consider performing extended PLND before RC and rechecking the presacral area for additional lymph nodes after RC, particularly in elderly patients with high co-morbidity for whom the duration of surgery matters.