Extended lymph node removal not beneficial for patients with clinically localized muscle-invasive bladder cancer

An extended lymphadenectomy  removal of additional lymph nodes beyond the extent of the standard procedure - in patients undergoing radical cystectomy (removal of bladder and nearby tissues) because of clinically localized muscle-invasive bladder cancer provides no patient benefit as measured by disease-free survival or overall survival times. It does, however, increase the risk of adverse events (side effects) and post-surgical death.

Once cancer invades the muscle of the bladder, it can also get into the blood and lymphatic system and can lodge in the lymph nodes. In about one-quarter of patients with muscle-invasive bladder cancer, the disease has already spread to regional lymph nodes. For this reason, after removing the bladder in these patients, surgeons will also remove all of the lymph nodes in the primary landing zone from around the bladder. Removing those lymph nodes - known as a lymphadenectomy - significantly reduces the chances of the cancer returning within the pelvis.

The SWOG S1011 trial asked whether it was better to extend the lymphadenectomy to remove even more lymph nodes from a wider area, and whether this would reduce the risk of recurrent disease or death. Surgeons participating in the trial had to first undergo a credentialing process designed specifically for the study. A total of 36 surgeons at 27 participating sites in the U.S. and Canada were credentialed, and they enrolled 658 patients, 618 of whom were eligible to be randomized.

These patients were randomized during their surgery, after the surgeon had determined the patient’s disease had not spread beyond the pelvis. All patients underwent a standard bilateral pelvic lymphadenectomy; those randomized to the investigative arm then also had an extended lymph node removal, with nodes removed at least up to the aortic bifurcation.

Patients on the extended lymphadenectomy arm were more likely to experience grade 3 or 4 adverse events (serious side effects) within 90 days of surgery, regardless of attribution, than patients who received a standard lymphadenectomy – 49 percent of patients versus 42 percent. Additionally, the number of deaths within 90 days of surgery was also greater on the investigative arm – 19 patients versus 7 patients.

Reference:

SWOG CANCER RESEARCH NETWORK,MEETING American Society of Clinical Oncology Annual Meeting