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Extended Lymph Nodes Removal Vs Standard Lymph Node Removal in Radical Cystectom
This information is for patients with muscle invasive bladder cancer facing for Radical Cystectomy.
A typical Radical Cystectomy includes removal of bladder, prostate and lymph nodes near bladder. There have been differences in clinical practice in how many (from how wider area) lymph nodes should be removed to mitigate the risk of metastasis at minimum. So, SWOG -SWOG is a National Cancer Institute supported organization that conducts clinical trials in adult cancer has been conducting clinical trial to compare pros and cons of removal of lymph nodes in standard area vs extended area. The result was announced at the recent conference.
At American Society of Clinical Oncology (ASCO) conference 2023, Dr. Lerner of Baylor College of Medicine presented the result of Phase 3 SWOG 1011 clinical trial which showed that there were not benefits with Extend Lymph Node Dissection (ELND) vs Standard Lymph Node Dissection (SLND) during Radical Cystectomy, Furthermore, patients with ELND experienced more complications including death.
I am aware of a urologist who stopped ELND in his clinical practice after the announcement of SWOG 1011 clinical trial.
ELND means to remove lymph nodes in wider area than SLND. See the figure below.
Side effects and complications comparison.
SLND(297 patients) ELND (292 patients)
Grade Grade
Adverse Events (AE) 3 4 5 3 4 5Anemia 6 1 0 9 0 0
Thromboembolic Event 1 1 1 6 1 1
Ileus 0 0 0 6 1 0
Sepsis 0 3 1 0 7 0
Death NOS 0 0 0 0 0 3
Stroke 0 0 0 0 0 1
Multi-organ failure 0 0 0 0 0 1
Myocardial Infarction 0 0 0 0 0 1
Maximum grade any AE 20 4 2 34 12 7AE Grade 3 : required Hospital Care, Grade 4: required hospitalization Grade 5 : death
The link to the article of SWOG 1011 at ASCO 2023.
https://meetings.asco.org/abstracts-presentations/218067 -
1 Reply
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Joe, as always, I look forward to your research. Thanks.
DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.
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