Importance of Node Dissection in Relation to Neoadjuvant and Adjuvant Therapy

Authors: William C. Huang MD1 and Bernard H. Bochner MD1
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  • 1 From the Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York.

Since the advent of effective chemotherapeutic regimens for treating transitional cell carcinoma, multimodal therapy has become part of the contemporary management of patients with muscle-invasive bladder cancer. However, radical cystectomy with pelvic lymphadenectomy remains the cornerstone of treatment for patients with localized and regionally advanced muscle-invasive disease. The effectiveness of chemotherapy models in bladder cancer can depend greatly on the quality of surgery. Unfortunately, without sufficient level I data, the boundaries of lymphadenectomy and the diagnostic and therapeutic ramifications of variations in the pelvic lymph node dissection remain undetermined. This article examines the role of pelvic lymph node dissection during perioperative chemotherapy and discusses the current challenges in establishing standards for lymphadenectomy in patients undergoing treatment for muscle-invasive bladder cancer.

Correspondence: Bernard H. Bochner, MD, Department of Urology, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY 10021. E-mail: bochnerb@mskcc.org
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