Perioperative outcomes using template mapping after radical cystectomy and extended lymph node dissection.

Background: To evaluate oncologic and perioperative outcomes of extended pelvic lymph node dissection (PLND) during robot-assisted radical cystectomy (RARC) based on the location of lymph node positivity (LN⁺).

Methods: We reviewed a tertiary center database of patients with bladder cancer who underwent extended PLND during RARC from 2004 to 2020. Patients were assigned to a standard (sPLN⁺) or extended (ePLN⁺) cohort based on LN⁺ location. ePLN⁺ patients were LN⁺ in one or more of the following: common iliac, presacral, aortic bifurcation, or paracaval packets. The Kaplan-Meier method estimated recurrence-free survival (RFS) and overall survival (OS). Perioperative 90-day complications were identified using the Clavien-Dindo system.

Results: Ninety patients were included; 43 (48%) were sPLN^+, and 47 (52%) were ePLN⁺. The median follow-up for sPLN⁺ and ePLN⁺ patients was 14.9 and 20.0 months, respectively. ePLN⁺ patients were older than sPLN⁺ patients (median age 75 vs. 68 years, p = 0.019). There were more ≤ cT1 LN⁺ patients in the sPLN⁺ cohort compared to the ePLN⁺ cohort (26% vs. 9%, p = 0.037). We recorded no differences in 90-day mortality or in RFS or OS between baseline and 12-year follow-up between groups (all, p > 0.05). Overall, the grade II or higher complication rate was 71%, with similar rates for the sPLN⁺ and ePLN⁺ (77% vs. 66%, p = 0.26) cohorts.

Conclusion: Location of LN⁺ does not affect oncologic outcomes in patients who underwent extended PLND. This underscores the lack of a notable therapeutic benefit beyond the standard dissection template.

Clinical trial number: Not applicable.