Laparoscopic pelvic lymphadenectomy is equivalent to traditional open surgical lymphadenectomy in bladder cancer

Objective: Is to evaluate the efficacy of laparoscopic extended pelvic lymphadenectomy in muscle invasive bladder cancer.
Material and Methods: Twenty five patients with operable muscle invasive bladder cancer were included in the study period between March 2001 and November 2001. There were 19 males and 6 females with a mean age of 55.2 years. Patients underwent laparoscopic pelvic lymphadenectomy followed by completion radical cystectomy and urinary diversion with the traditional open technique. The two procedures were done by two independent surgeons. Evaluation criteria included operative time, adequacy of the lymphadenectomy and presence of any residual lymphatic tissue.
Results: Three patients were found to have metastatic disease on initial laparoscopic exploration. In one patient, uncontrollable bleeding from avulsed obturator vessels prompted urgent laparotomy. Twenty one laparoscopic procedures were available for evaluation. There were 17 males and 4 females with a mean age of 53.1 years. Average operation time was 75 minutes and showed 30% reduction by the end of the study. The average number of lymph nodes resected per patient was 8.2 (range 4-11). Residual fibro-fatty tissue was encountered in three patients early in the study period (first 15 patients) and was mainly due to a learning curve. No residual lymph nodes were detected in the cystectomy specimens.
Conclusion: Laparoscopic pelvic lymphadenectomy is technically feasible and will produce lymphatic yield similar to that of open traditional surgery. It can be used as a staging procedure to allow for neo-adjuvant therapy in muscle invasive bladder cancer. It also can be incorporated with total laparoscopic radical cystectomy and urinary diversion as a single procedure.