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Question 8#

The limits of dissection of a standard pelvic lymphadenectomy in cases of radical cystectomy include the following, EXCEPT:

A) Obturator nerve laterally
B) Bladder medially
C) Bifurcation of the common iliac artery cephalad
D) Endopelvic fascia caudally

Correct Answer is A

Comment:

Answer A

Apart from the B–D above, the limits of dissection of the standard pelvic lymphadenectomy includes the genitofemoral nerve laterally, not the obturator nerve. Many researchers now recommend an extended lymphadenectomy with the cephalad limits of dissection extending up to the aortic bifurcation and including caudally the presacral nodes. Not only does an extended lymph node dissection provide additional data for tumour staging, but survival might also be improved by this technique. Removal of more than 15 lymph nodes has been postulated to be both sufficient for the evaluation of the lymph node status as well as beneficial for overall survival in retrospective studies.

Further Reading:

  1. Ghoneim MA, Abol-Enein H. Lymphadenectomy with cystectomy: Is it necessary and what is its extent? Eur Urol 2004; 46(4): 457–461.
  2. Wright JL, Lin DW, Porter MP. The association between extent of lymphadenectomy and survival among patients with lymph node metastases undergoing radical cystectomy. Cancer 2008; 112: 2332–2333.