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Radical cystectomy with bilateral pelvic lymphadenectomy and trimodality bladder-sparing therapy or TMT, are both curative options for patients with nonmetastatic muscle invasive bladder cancer. Patients should be afforded the opportunity for a multidisciplinary evaluation with equipoise in discussing these options for eligible patients. We discuss the barriers to broader acceptance and utilization of TMT and encourage support of clinical trials of TMT.

International audience; Objectives: To compare oncologic outcomes of patients with early-stage cervical cancer and negative nodes who underwent sentinel lymph node biopsy alone (SLNB) versus pelvic lymphadenectomy (PL).Methods: An ancillary analysis of two prospective multicentric trials on SLN biopsy for cervical cancer (SENTICOL I and II) was conducted. Only patients with early-stage cervical cancer (IA to IIA FIGO stage), bilateral detection of SLN, negative SLN after ultrastaging and negative non-SLN after final pathologic examination were included. Risk-factors of recurrence and disease-specific mortality were determined by Cox proportional hazard models.Results: Between January 2005 and July 2012, 259 node-negative patients were analyzed: 87 in the SLNB group and 172 in the PL group. The median follow-up was 47 months [4-127]. During the follow-up, 21 patients (8.1%) experienced recurrences, including 4 nodal recurrences (1.9%), and 9 patients (3.5%) died of cervical cancer. Disease-free survival (DFS) and disease-specific survival (DSS) were similar between SLNB and PL groups, 85.1% vs. 80.4%, p = 0.24 and 90.8% vs. 97.2%, p = 0.22 respectively. By Cox multivariate analysis, SLNB compared to PL was not associated with DFS (HR = 1.78, 95%CI = [0.71-4.46], p = 0.22) neither with DSS (HR = 3.02, 95%CI = [0.69-13.18], p = 0.14). Only pathologic risk level according to the Sedlis criteria was an independent predictor of DFS and DSS.Conclusions: Omitting full pelvic lymphadenectomy for patients with bilateral negative SLN does not seem to be associated with an increased risk of recurrence in this series. Survival non-inferiority needs to be confirmed by prospective trials.

Objective: Sentinel lymph-node (SLN) mapping with indocyanine green (ICG) and near-infrared (NIR) imaging is a feasible alternative to pelvic lymphadenectomy in endometrial cancer staging. While IC...

This paper aimed to explore pelvic lymphadenectomy for gynecological malignant tumors guided by computed tomography angiography (CTA) images under region-growing algorithm (RGA). 100 cases of malignant tumor patients who received pelvic lymphadenectomy in hospital from January 2018 to January 2020 were analyzed. Patients were classified into control group (CTA image) and experimental group (RGA-based CTA image), each with 50 cases. The overall accuracy (OA) of the pelvic CT image segmentation parameters under RGA, the watershed segmentation algorithm (WA), and the swarm intelligence optimization algorithm (SIOA) was compared. Comparisons of segmentation parameters, denoising performance, and CT imaging of patients as well as diagnosis rate and total efficiency rate were carried out. The results showed that overall accuracy (OA) of RGA was considerably higher versus watershed segmentation algorithm (WA) and swarm intelligence optimization algorithm (SIOA). However, false positive rate (FPR) and false negative rate (FNR) of RGA were greatly lower than those of other algorithms. RGA greatly improved the accuracy of pelvic tumor detection. The peak signal-to-noise ratio (PSNR) of RGA was superior to that of WA and SIOA, but differences in edge preservation index (EPI) value were not significant. The diagnosis rate of the experimental group was 48/50 (96%), while the diagnosis rate by manual means was 38/50 (76%). For the diagnosis rate and total efficiency, results of the experimental group were evidently higher in contrast to the control group ( P < 0.05 ). In conclusion, under RGA, CTA image-guided pelvic lymphadenectomy had good segmentation accuracy and denoising performance, and it was superior in total efficiency and diagnosis rate, which was worthy of clinical promotion.

OBJECTIVES: Sentinel lymph node (SLN) mapping may replace staging radical pelvic lymphadenectomy in women with early-stage cervical cancer. In a national multicenter setting, we evaluated SLN mapping in women with early-stage cervical cancer and investigated the accuracy of SLN mapping and FDG-PET/CT in tumors >20 mm.METHODS: We prospectively included women with early-stage cervical cancer from March 2017-January 2021 to undergo SLN mapping. Women with tumors >20 mm underwent completion pelvic lymphadenectomy and removal of FDG-PET/CT positive nodes. We determined SLN detection rates, incidence of nodal disease, sensitivity and negative predictive value (NPV) of SLN mapping, and the sensitivity, specificity, NPV, and positive predictive value (PPV) of FDG-PET/CT.RESULTS: We included 245 women, and 38 (15.5%) had nodal metastasis. The SLN detection rate was 96.3% (236/245), with 82.0% (201/245) bilateral detection. In a stratified analysis of 103 women with tumors >20 mm, 27 (26.2%) had nodal metastases. The sensitivity of SLN mapping adhering to the algorithm was 96.3% (95% CI 81.0-99.9%) and the NPV 98.7% (95% CI 93.0-100%). For FDG-PET/CT imaging the sensitivity was 14.8% (95% CI 4.2-33.7%), the specificity 85.5% (95% CI 75.6-92.5%), the NPV 73.9% (95% CI 63.4-82.7%), and the PPV 26.7% (95% CI 7.8-55.1%).CONCLUSIONS: SLN mapping seems to be an adequate staging procedure in early-stage cervical cancer tumors ≤20 mm. In tumors >20 mm, SLN mapping is highly sensitive but demands full adherence to the SLN algorithm. We recommend completion pelvic lymphadenectomy in tumors >20 mm until the oncological safety is established. FDG-PET/CT for nodal staging of women with early-stage cervical cancer seems limited.

Background The value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s. This is mainly due to the fact that the relation between lymph node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general. Patients and Methods N = 514 patients with primary vulvar squamous cell cancer (VSCC) FIGO stage ≥ IB were treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2018. In this analysis, patients with pelvic LAE (n = 21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph node involvement. Results The majority had T1b/T2 tumors (n = 15, 78.9%) with a median diameter of 40 mm (11–110 mm). 17/21 patients showed positive inguinal nodes. Pelvic nodal involvement without groin metastases was not observed. 6/17 node-positive patients with positive groin nodes also had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5 (1–8)). These 6 patients were highly node positive with median 4.5 (2–9) affected groin nodes. With regard to the metastatic spread between groins and pelvis, no contralateral spread was observed. Five recurrences were observed after a median follow-up of 33.5 months. No pelvic recurrences were observed in the pelvic nodal positive group. Patients with pelvic metastasis at first diagnosis had a median progression-free survival of only 9.9 months and overall-survival of 31.1 months. Conclusion A relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, therefore pelvic staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC.

Intravascular tumor thrombus (ITT) is a dangerous condition defined as tumor extension into a blood vessel. Endometrial stroma sarcomas (ESS) rarely involve the great vessels [1]. ESS are rare, indolent tumors that account for 25% of uterine sarcomas [2], and they are usually classified as low-grade (LG) or high-grade (HG) [3]. Whilst 29 LG-ESS cases of ITT have been described in the literature since 1986 (Table 1), no cases of ITT from HG-ESS have been reported yet. The present study reports the case of a 57-year-old patient with a recurrence of HG-ESS. Five years before presenting at our institution, the patient underwent total abdominal hysterectomy with bilateral adnexectomy and systematic pelvic lymphadenectomy, followed by chemo-radiotherapy for HG-ESS (FIGO stage III C) [4]. During routine follow-up, a computed tomography (CT) scan diagnosed a recurrence of HG-ESS at the para-caval lymph nodes.

Objective To compare the degree of agreement and consistency of urodynamic studies (UDS) with low urinary tract symptoms (LUTS) questionnaires for evaluating LUTS in cervical cancer patients following radical hysterectomy (RH) and pelvic lymphadenectomy. Methods From January 2012 to March 2015, 204 cervical cancer patients who underwent RH in 13 hospitals were evaluated using the Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and the Overactive Bladder Symptom Score (OABSS). Urodynamic tests were also performed on these patients during the same period. Results Study participants’ age ranged from 23 to 75 years, with a mean (standard deviation) of 48.0 ​± ​9.3 years. Using questionnaires, the prevalence of patients with LUTS symptoms, including storage symptoms, voiding symptoms, stress urinary incontinence (SUI) and overactive bladder (OAB) was 86.3%, 77.0%, 62.7%, 52.9% and 14.7%, respectively. For UDS, the corresponding prevalence was 89.7%, 70.1%, 66.7%, 46.6% and 13.2%, respectively. The diagnostic concordance of questionnaires and UDS for storage symptoms, voiding symptoms, SUI and OAB was 79.9%, 66.7%, 66.7%, 57.4% and 79.9%, respectively. For voiding symptoms, the correlation coefficient was 0.272, which was higher than that of storage symptoms, SUI and OAB. Conclusions In cervical cancer patients who have undergone RH, there was a moderate degree of agreement between UDS and symptom questionnaires in evaluating LUTS, but the consistency was poor. Medical personnel should be adequately trained in UDS to ensure LUTS are adequately diagnosed in patients.

Objectives. To find out sentinel lymph node detection rate of low-risk endometrial cancer patients. To compare postoperative complications rate, lenght of a surgery, lenght of hospital stay and sensitivity of detecting lymph node metastasis between minimally invasive surgery with sentinel lymph node biopsy and abdominal surgery with systemic pelvic lymphadenectomy. Methods. Retrospective analysis of low-risk endometrial cancer patients, treated in National Cancer Institute (n = 103) history cases from 2018 10 untill 2019 12. I group – laparoscopic hysterectomy with sentinel lymph node biopsy (n = 35); II group – abdominal hysterectomy with systemic pelvic lymphadenectomy (n = 68). Both groups were homogeneous according to clinicopathological features. Results. Sentinel lymph node were detected in 97.1% cases. Sentinel lymph nodes in both sides were detected in 85.7% cases. Metastasis in regional lymph nodes were detected in 2 cases (5.7%) in group I and none group II. Postoperative complications rate in group I were 3.8% and 13% in group II. Conclusions. There are significantly less postoperative complications in endoscopic surgery with sentinel node biopsy for low-risk endometrial cancer treatment, also this method is more accurate in surgical staging in National Cancer Institute.

Since the publication of the updated German guideline in 2015, the recommendations for performing pelvic lymphadenectomy (LAE) in patients with vulvar cancer (VSCC) have changed considerably. The guideline recommends surgical lymph node staging in all patients with a higher risk of pelvic lymph node involvement. However, the current data do not allow the population at risk to be clearly defined, therefore, the indication for pelvic lymphadenectomy is still not clear. There are currently two published German patient populations who had pelvic LAE which can be used to investigate both the prognostic effect of histologically verified pelvic lymph node metastasis and the relation between inguinal and pelvic lymph node involvement. A total of 1618 patients with primary FIGO stage ≥ IB VSCC were included in the multicenter AGO CaRE-1 study (1998 – 2008), 70 of whom underwent pelvic LAE. During a retrospective single-center evaluation carried out at the University Medical Center Hamburg-Eppendorf (UKE), a total of 514 patients with primary VSCC treated between 1996 – 2018 were evaluated, 21 of whom underwent pelvic LAE. In both cohorts, around 80% of the patients who underwent pelvic LAE were inguinally node-positive, with a median number of three affected groin lymph nodes. There were no cases of pelvic lymph node metastasis without inguinal lymph node metastasis in either of the two cohorts. Between 33 – 35% of the inguinal node-positive patients also had pelvic lymph node metastasis; the median number of affected groin lymph nodes in these patients was high (> 4), and the maximum median diameter of the largest inguinal metastasis was > 40 mm in both cohorts. Pelvic lymph node staging and pelvic radiotherapy is therefore probably not necessary for the majority of node-positive patients with VSCC, as the relevant risk of pelvic lymph node involvement was primarily found in node-positive patients with high-grade disease. More, ideally prospective data collections are necessary to validate the relation between inguinal and pelvic lymph node involvement.

Background Thinking of the rarity and malignancy of gynecologic tract carcinosarcomas (GTCS), the aim of the study was to investigate the possible predictors of relapse-free survival (RFS) and overall survival (OS) for GTCS patients. Methods We performed a retrospective cohort study of women with GTCS at our hospital between January 2009 and December 2013. We used the Kaplan-Meier method to calculate RFS and OS, and Cox regression analysis to define the survival effects of risk factors. Results A total of 45 GTCS patients were included in the study. The median follow-up time was 46 months. Cox regression analysis showed that lymph node metastasis was significantly associated with worse RFS (HR: 3.145; 95%CI: 1.181-8.378; P=0.022) and OS (HR: 4.065; 95%CI: 1.57-10.524; P=0.004). Pelvic lymphadenectomy had a favorable RFS (HR: 0.213; 95%CI: 0.057-0.796; P= 0.021). Conclusion Lymph node metastasis significantly affected the prognosis of uterine carcinosarcoma. Pelvic lymphadenectomy could reduce the relapse rate of GTCS patients.

Caiyan Liu,1 Jianguo Zhao,1 Shasha Liu,1 Yaomei Ma,2 Yun Yang,3 Pengpeng Qu1 1Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People’s Republic of China; 2Department of Gynecological Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, People’s Republic of China; 3Department Of Gynecology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People’s Republic of ChinaCorrespondence: Pengpeng QuDepartment of Gynecological Oncology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, People’s Republic of ChinaTel +86-18920196050Email qu.pengpeng@hotmail.comPurpose: To determine whether pelvic lymphadenectomy improved survival in patients diagnosed with low-risk early-stage endometrial cancer by intraoperative pathology.Methods: This retrospective analysis included 238 patients at our hospital.Results: The lymphadenectomy and non-lymphadenectomy groups contained 121 and 117 patients, respectively. In both groups, more than half the patients had tumor size ≥ 2 cm, and most had myometrial invasion < 50%, stage Ia disease and no lymphovascular space invasion. Age, tumor size, myometrial invasion, surgical-pathologic stage and postoperative adjuvant therapy use were comparable between groups. The non-lymphadenectomy group had more patients treated laparoscopically (36.8% vs 10.7%; P< 0.001) and fewer patients with histologic grade 2 disease (35.9% vs 62.8%; P< 0.001) than the lymphadenectomy group. In the non-lymphadenectomy group, intraoperative frozen section pathology disagreed with postoperative pathology in only 31/117 cases for histologic grade (none upgraded to grade 3), 1/117 cases for myometrial invasion (one case revised from < 50% to ≥ 50%) and 3/117 cases for surgical-pathologic stage (upgraded from Ia to Ib or II). Disease recurrence rate and overall survival did not differ significantly between the lymphadenectomy and non-lymphadenectomy groups. In multivariate Cox regression analysis, only surgical-pathologic stage >Ia (odds ratio, 47.7; 95% confidence interval, 6.7– 340.8; P=0.031) was associated with increased odds of disease recurrence.Conclusion: Pelvic lymphadenectomy may not be necessary in patients with an intraoperative diagnosis of low-risk endometrial cancer.Keywords: endometrial cancer, lymph node excision, prognosis, recurrence, survival

To evaluate the feasibility of cervical conization and laparoscopic pelvic lymphadenectomy as a fertility-sparing surgery to treat early-stage cervical cancer.We conducted a retrospective analysis from a prospectively maintained database of patients with stage IA1-IB1 grossly invisible cervical cancers undergoing conization plus laparoscopic lymphadenectomy between January 2014 and July 2019.Forty patients were identified. Five patients (12.5%) had stage IA1 with lymphovascular space invasion, 21 (52.5%) had stage IA2, and 14 (35.0%) had stage IB1. All of the patients had tumors2 cm. Histology included 35 (87.5%) squamous-cell carcinomas, three (7.5%) adenocarcinomas, and two (5.0%) adenosquamous carcinomas. Median duration of the procedure was 105 min (range, 31-219), and the median estimated blood loss was 50 ml (range, 30-200). One patient received abdominal radical trachelectomy due to the presence of positive margin after conization. Three patients developed postoperative cervical stenosis. After a median follow-up of 35 months (range, 8-74), only one patient (2.5%) developed a recurrence in the remaining cervix, and no patients died. Four of 17 patients attempting to conceive had a spontaneous pregnancy: three delivered at term and one was currently pregnant.Cervical conization and pelvic lymphadenectomy seems to be an acceptable treatment for well-selected patients with low-risk, early-stage cervical cancer who wish to preserve fertility. It offers excellent oncologic outcomes, low perioperative morbidities, and good reproductive results. Further large prospective studies are warranted to prove the effectiveness of this surgery.

ZusammenfassungDer Review von Fossati 2017 stellt den Wert der pLA im Rahmen der RP in Frage, weil sich aus den vorliegenden Studien kein onkologischer Nutzen ergibt. Nach wie vor ist die Beweislage wegen fehlender Evidenz dürftig. Unsere Feststellung, dass von metastasierten LK keine Streuung bisher nachgewiesen wurde, basiert auf Registerdaten, auf klinischen Studien ohne Nachweis eines pLA-Vorteils und auf Überlegungen zum genetischen Zusammenhang von LK- und Fernmetastasen. Der Verzicht auf die pLA bzw. auf die Bestrahlung eines Beckenfeldes wird durch die verbesserte Bildgebung mit dem 68Ga PSMA-PET-CT zum Nachweis von Metastasen erleichtert. Wenn LK nicht metastasieren, wird das Ergebnis der Bildgebung diagnostisch zur Therapieplanung ausreichen. Somit kann auf die pLA aus diagnostischen Gründen verzichtet werden. Komplikationen wären ausgeschlossen. Um die Frage zu klären, ob die pLA bzw. ein multimodales Behandlungskonzept intermediate- und high risk-Patienten nützen, wird ein RCT notwendig sein, in dem v. a. der nicht vollständig entfernte Primarius als Streuquelle berücksichtigt wird.

Presented by: Ignacio Zapardiel Cervical cancer is the most common cancer-related cause of death among young women with almost 570 000 new cases per year worldwide.1 The standard of care for patients with early stage disease is radical hysterectomy and pelvic lymphadenectomy with or without

The purpose of the study was to evaluate a combined approach to surgical treatment of patients with morbid obesity. Material and methods . Between January 2017 and December 2018, 26 women with stage I endometrial cancer underwent laparoscopic gysterectomy in combination with panniculectomy. Results . No episodes of intraoperative hemodynamic instability, significant hypoxemia or hypercapnia were reported. The average blood loss was 236.4 ± 114.8 ml; surgery time: 264.2 ± 57.3 min; mass of the removed flap: 10.52 ± 6.5 kg; length of hospital stay: 11.2 ± 3.7 days. There was no delay in the start of adjuvant radiation therapy. Conclusion. Surgical treatment of endometrial cancer patients with morbid obesity presents significant technical challenges. The choice of surgical access in such cases may depend not on the stage and prevalence of the tumor, but on the constitutional characteristics of the patients. Sometimes surgeons can refuse to perform surgery for such patients and offer them an alternative treatment. Classical laparotomic access is associated with the maximum risk of perioperative complications. Laparoscopic techniques have technical limitations associated, for example, with the length of trocars and surgical instruments. Robotic surgery is considered generally safe, but due to its low availability, it is limited only to large clinical centers . The combined approach to surgical treatment of endometrial cancer patients with morbid obesity is the most effective surgical modality for these patients.

Pelvic lymphadenectomy is a supplementary part of staging and treatment in gynecologic oncology. Additionally, it influences the prognosis and guides the adjuvant treatment. The role of lymphadenectomy in ovarian cancer is controversial, in endometrial cancer high-risk patient groups deserve lymphadenectomy and in cervical cancer lymphadenectomy is a complementary part of the surgical treatment. Lymphadenectomy can be performed in a selective or systematic approach. This video demonstrates a right-side systematic pelvic lymphadenectomy in a cadaveric model. WOS:000523502503326 Q3

International audience; Background/Aim: This study aimed to determine whether a pelvic and para-aortic lymphadenectomy (PPAL) improves survival compared with a pelvic lymphadenectomy (PL) in patients with endometrial cancer. Patients and Methods: Data from all women operated for endometrial cancer between 1998 and 2013 were extracted from the Surveillance, Epidemiology and End Results database. Women treated with PL were matched with those treated with PPAL according to age and risk of recurrence. The primary endpoint was disease-specific survival (DSS). Results: A total of 1015 patients who underwent PL were matched with 1015 patients who underwent PPAL. The 3-year DSS probabilities for patients at intermediate- and high-risk (IHR) of recurrence were similar in the PPAL group and the PL group. Multivariate analysis of prognostic factors indicated that in patients with an IHR of recurrence, PPAL did not reduce the risk of death compared with PL. Conclusion: For patients with an IHR of recurrence, the extent of lymphadenectomy does not impact DSS.

High-risk non-muscle invasive bladder cancer is marked by frequent disease recurrences and risk of stage progression, contributing to high surveillance, treatment-related costs, and patient anxiety. Although the mainstay of high-risk non-muscle invasive bladder cancer clinical management remains transurethral resection followed by intravesical bacillus Calmette-Guerin (BCG), patients who develop BCG-unresponsive disease have few salvage options outside of a radical cystectomy with pelvic lymphadenectomy. This article provides a historical context relevant to the development of the BCG-unresponsive definition, an overview of current clinical trial expectations, and an introduction to this issue of Urologic Clinics.

Introduction: Quality of care is an emerging concern, notably in oncology. The aim of the present study was to identify the sociodemographic factors influencing the quality of care in the USA concerning the surgical management of endometrial cancer (EC) through the Surveillance Epidemiology and End Results (SEER) database using already published Belgian quality indicators (QI). Methods: Using the SEER database 1988–2013, we identified 151,752 patients treated for EC. Six QI were extracted from a Belgian study on quality of care in EC because of their applicability to the SEER. These QI evaluated only the surgical management. We examined the association between sociodemographic characteristics and quality of care with a logistic regression model. We compared our results with those defined as theoretical target by the Belgian initiative and considered a QI to be accurately met if >80% of the population met the indicator, moderately met between 50 and 80%, and poorly met under 50%. Results: Concerning the 6 surgical QIs, one was accurately met, 3 were moderately met, and 2 were poorly met. For example, 73% of the patients with a high-risk EC underwent a pelvic lymphadenectomy. Age over 75 years old, black ethnicity, lower-income group, without partner, and uninsured had a negative impact on adherence to QIs. Conclusion: Demographic discrepancies persist in the surgical management of EC, impacting evidence-based care.

Contains fulltext : 220978.pdf (Publisher’s version ) (Open Access) AIM: Recently, the safety of laparoscopic radical hysterectomy (LRH) has been called into question in early-stage cervical cancer. This study aimed to evaluate overall survival (OS) and disease-free survival (DFS) in patients treated with abdominal radical hysterectomy (ARH) and LRH for early-stage cervical cancer and to provide a literature review. METHODS: Patients diagnosed between 2010 and 2017 with International Federation of Gynaecology and Obstetrics (2009) stage IA2 with lymphovascular space invasion, IB1 and IIA1, were identified from the Netherlands Cancer Registry. Cox regression with propensity score, based on inverse probability treatment weighting, was applied to examine the effect of surgical approach on 5-year survival and calculate hazard ratios (HR) and 95% confidence intervals (CIs). Literature review included observational studies with (i) analysis on tumours /=30 months (iii) >/=5 events per predictor parameter in multivariable analysis or a propensity score. RESULTS: Of the 1109 patients, LRH was performed in 33%. Higher mortality (9.4% vs. 4.6%) and recurrence (13.1% vs. 7.3%) were observed in ARH than LRH. However, adjusted analyses showed similar DFS (89.4% vs. 90.2%), HR 0.92 [95% CI: 0.52-1.60]) and OS (95.2% vs. 95.5%), HR 0.94 [95% CI: 0.43-2.04]). Analyses on tumour size (/=2 cm) also gave similar survival rates. Review of nine studies showed no distinct advantage of ARH, especially in tumours

RESUMEN : Introducción: El tratamiento estándar del cáncer de vejiga músculo infiltrante es la cistectomía radical junto a la linfadenectomía pélvica. Las complicaciones linfáticas resultantes de la linfadenectomía no están muy bien descritas en la literatura. Entre las complicaciones más frecuentes se encuentran el linfocele y el linfedema. Objetivos: El objetivo de nuestro trabajo es evaluar la incidencia de complicaciones linfáticas secundarias a la cistectomía radical y linfadenectomía pélvica, así como su correlación con diversos factores perioperatorios a medio y largo plazo. Material y Métodos: Se llevó a cabo un estudio descriptivo retrospectivo de pacientes a los que se les había realizado cistectomía radical con linfadenectomía pélvica entre septiembre de 2018 y febrero de 2021 en el Hospital Universitario Marqués de Valdecilla. Resultados: Se intervinieron un total de 71 pacientes. El abordaje de la cistectomía realizado con mayor frecuencia fue el robótico (87,3%). Si nos referimos al tipo de linfadenectomía, fue de tipo extendida en el 91,4% de los casos y super-extendida en el 8,6%. Las complicaciones linfáticas reportadas con mayor frecuencia fueron el linfedema (28,5%), y el linfocele (21,4%). Se encontraron relaciones estadísticamente significativas entre la toma de antiagregante y el desarrollo de linfocele, así como entre linfedema y exitus (ajustado por edad y sexo). Conclusión: Las complicaciones linfáticas debidas a la cistectomía radical y linfadenectomía pélvica no son muy frecuentes. Las complicaciones encontradas con mayor frecuencia en nuestro estudio han sido el linfedema y el linfocele. ABSTRACT : Introduction: The standard treatment for muscle-infiltrating bladder cancer is radical cystectomy with pelvic lymphadenectomy. Lymphatic complications resulting from lymphadenectomy are not well described in to literature. The most frequent complications are lymphocele and lymphedema. Purpose: The purpose of our study is to evaluate the incidence of lymphatic complications due to radical cystectomy and pelvic lymphadenectomy, as well as their correlation with various mid- and long- term perioperative factors. Material and methods: A retrospective descriptive study was carried out in patients who underwent radical cystectomy and pelvic lymphadenectomy between September 2013 and February 2021 in Marqués de Valdecilla University Hospital. Results: A total of 71 patients underwent surgery. The most frequently performed cystectomy approach was robotic (87.3%). Regarding the type of lymphadenectomy, it was extended in 91,4% of cases and super-extended in 8.6%. The most frequent reported lymphatic complications were lymphedema (28,5%), and lymphocele (21,4%). Statistically significant relationships were found between taking antiplatelet agents and the development of lymphocele, as well as between lymphedema and death (adjusted for age and sex). Conclusion: Lymphatic complications due to radical cystectomy and pelvic lymphadenectomy are not very frequent. The most frequent complications found in our study were lymphedema and lymphocele. Grado en Medicina

Background: Although lymphadenectomy is advised for accurate surgical endometrial-carcinoma staging, the procedure is not performed regularly worldwide. Most studies on it include few patients and mainly compare pelvic with pelvic/para-aortic lymphadenectomy. Comparing lymphadenectomy with non-lymphadenectomy is rare. The current study examined prognostic significance and survival advantages of pelvic and pelvic/para-aortic lymphadenectomy compared to no lymphadenectomy. Materials and Methods: This was a retrospective cohort analysis of 75 patients with endometrial carcinomas. The patients were divided into 3 treatment groups based on whether or not lymph-node dissection was performed and the extent of the dissections: (1) pelvic lymphadenectomy; (2) pelvic/para-aortic lymphadenectomy; and (3) no lymphadenectomy. Correlations were analyzed among the surgical techniques used for the 3 groups with respect to the need for adjuvant radiotherapy or chemotherapy, recurrences, and survival outcomes. Results: Pelvic and pelvic/para-aortic lymphadenectomy produced more-favorable overall survival (OS) and progression-free survival (PFS) rates than no lymphadenectomy (p = 0.047). A significant difference was noted among the 3 treatment groups for OS rate and disease-free survival rates (p = 0.015 and 0.017, respectively). The recurrence rates were 47.1%, 35.7%, and 68.8% in the pelvic lymphadenectomy, and pelvic/para-aortic lymphadenectomy, and no lymphadenectomy groups, respectively (p = 0.037). Conclusions: This study showed that pelvic and para-aortic lymphadenectomy improved the OS and PFS rates of patients with endometrial cancer.

Laparoscopic salpingo-oophorectomy and pelvic lymphadenectomy place the ureter at risk. Although traditional anatomic studies indicate that ureters generally cross over the common iliac artery in the pelvic inlet, the view is often different during surgery. Hence, digital three-dimensional models have been utilized to solve this conundrum. Our study aimed to evaluate the anatomic relation between the iliac artery and the ureter in the pelvic inlet.A medical image processing system processed data collected from 129 female patients, and digital 3D models of the iliac artery and ureter were used to study their anatomic relation. Left- and right-side data were compared using Pearson's χTwo different anatomic relations were found immediately posterior to the ureter: Common iliac arteries were present in 33.2% and external iliac arteries in 76.8%. The mean distances from the point at which the ureter crossed over the iliac artery until the bifurcation of the artery was 8.8 ± 12.2 mm in the left pelvis and 12.4 ± 10.8 mm in the right pelvis - different from that of the traditional anatomic study.In the future, these models and digital anatomical data could help avoid surgical complications.

Objectives For early-stage endometrial cancer, laparoscopic surgery is well established in many countries. In Japan, the procedure is covered by insurance from 2014. Since then, laparoscopic surgeries for gynecological cancers have been performed by not only gynecolo-oncologists but also laparoscopic qualified gynecologists. To review the safety of our cases, this IRB-approved study was performed. Methods Operative cases of endometrial cancer were reviewed retrospectively. Results Out of 94 stage I endometrial cancer cases who underwent laparoscopic surgery, total laparoscopic modified radical hysterectomy + laparoscopic pelvic lymphadenectomy was performed for 22 patients. Median operative duration was 238 minutes, and median blood loss was 100mL. We experienced two cases of obturator nerve complete transection. Both of the surgeons were laparoscopic board certificated. In both cases, right obturator nerve was cut near to the branch of internal iliac vein. Surgical video can be revisited for one patient. The nerve covered with lymphatic tissue was dragged out medially under the internal iliac branch, and cut misinterpreted as a lymphatic trunk. For both, although nerve correction was done during surgery by suturing, rehabilitation was necessary. For open surgery, we have never experienced obturator nerve injury during the pelvic lymphadenectomy in the same period. Conclusions Obturator nerve injury during pelvic surgery is possibly frequent in laparoscopic surgery.

Introduction: Pelvic lymph node dissection (PLND) during robotic prostatectomy is associated with potential complications. The most common complication of PLND is lymphoceles, occurring in up to 50...

Introduction/Background* Retroperitoneal lymphadenectomy of the pelvis is rarely performed due to its apparently high degree of difficulty. More and more clinical situations, especially in young people or those with medical problems, require breaking the treatment down into several steps. Methodology The featured video describes the pelvic right retroperitoneal lymphadenectomy procedure. Result(s)* As a result we present step by step procedure. Conclusion* Retroperitoneal lymphadenectomy of the pelvis is a skill that should be mastered by everyone involved in endoscopic surgery in gynecological oncology.

Aim The aim of this study was to compare the surgical outcomes between patients who were staged laparoscopically for early-stage endometrioid-type endometrial cancer (EC) between those who underwent prophylactic ligation of uterine arteries (UAs) prior to pelvic lymphadenectomy and the patients who were operated with standard procedure. Methods This retrospective study was conducted in women diagnosed with early-stage and low/intermediate-risk endometrioid-type EC. The control group included patients who underwent standard laparoscopic pelvic lymphadenectomy and the study group concerned patients who underwent prophylactic ligation of UA prior to pelvic lymphadenectomy. The prophylactic ligation of UA procedure was performed at a point just proximal to its origin. Results The mean lymph node count dissected in the study group was higher in terms of statistical significance (17.5 +/- 2.2 vs. 19.8 +/- 3.6, p = 0.003 and p < 0.05). The rate of the patients who had a positive pelvic lymph node detected did not differ between groups (7.4% vs. 16.7%, p = 0.258 and p < 0.05). The operation time (OT) of the patients in the study group did not differ between groups (p = 0.546 and p < 0.05). Hemoglobin drop (-0.5 +/- 0.7) and hematocrite drop (-0.8 +/- 0.9) values in the study group were found to be lower in the study group (p = 0.000, p = 0.000, and p < 0.05). Conclusions Performing prophylactic ligation of UA at its origin prevents unwanted bleeding and facilitates the laparoscopic pelvic lymphadenectomy procedure. WOS:000700243300001 2-s2.0-85115674696 PubMed: 34571568

INTRODUCTION AND OBJECTIVE:Pelvic lymphadenectomy (PLN) during Retzius-Sparing Robotic-Assisted Radical Prostatectomy (RS-RARP) may be challenging because the medial umbilical ligaments are not rel...

BackgroundLymph node metastasis (LNM) is a critical unfavorable prognostic factor in endometrial cancer (EC). At present, models involving molecular indicators that accurately predict LNM are still uncommon. We addressed this gap by developing nomograms to individualize the risk of LNM in EC and to identify a low-risk group for LNM.MethodsIn all, 776 patients who underwent comprehensive surgical staging with pelvic lymphadenectomy at the First Affiliated Hospital of Chongqing Medical University were divided into a training cohort (used for building the model) and a validation cohort (used for validating the model) according to a predefined ratio of 7:3. Logistics regression analysis was used in the training cohort to screen out predictors related to LNM, after which a nomogram was developed to predict LNM in patients with EC. A calibration curve and consistency index (C-index) were used to estimate the performance of the model. A receiver operating characteristic (ROC) curve and Youden index were used to determine the optimal threshold of the risk probability of LNM predicted by the model proposed in this study. Then, the prediction performance of different models and their discrimination abilities for identifying low-risk patients were compared.ResultLNM occurred in 87 and 42 patients in the training and validation cohorts, respectively. Multivariate logistic regression analysis showed that histological grade (P=0.022), myometrial invasion (P=0.002), lymphovascular space invasion (LVSI) (P=0.001), serum CA125 (P=0.008), Ki67 (P=0.012), estrogen receptor (ER) (0.009), and P53 (P=0.003) were associated with LNM; a nomogram was then successfully established on this basis. The internal and external calibration curves showed that the model fits well, and the C-index showed that the prediction accuracy of the model proposed in this study was better than that of the other models (the C-index of the training and validation cohorts was 0.90 and 0.91, respectively). The optimal threshold of the risk probability of LNM predicted by the model was 0.18. Based on this threshold, the model showed good discrimination for identifying low-risk patients.ConclusionCombining molecular indicators based on classical clinical parameters can predict LNM of patients with EC more accurately. The nomogram proposed in this study showed good discrimination for identifying low-risk patients with LNM.

An adequate pelvic lymph node dissection (PLND) is an essential part of radical cystectomy for muscle invasive bladder cancer. However, the definition of what constitutes an adequate PLND is often shrouded in controversy. Various authors have defined different anatomic templates of PLND based on levels of pelvic lymph nodes. Some have suggested other surrogate markers of the adequacy of PLND, namely lymph node count and lymph node density. While individual studies have shown the efficacy and reliability of some of the above markers, none of them have been recommended forthright due to the absence of robust prospective data. The use of non-standardized nomenclature while referring to the above variables has made this matter more complex. Most of older data seems to favor use of extended template of PLND over the standard template. On the other hand, one recent randomized controlled trial (RCT) did not show any benefit of one template over the other in terms of survival benefit, but the study design allowed for a large margin of bias. Therefore, we conducted a systematic search of literature using EMBASE, Medline, and PubMed using PRISMA-P checklist for articles in English Language published over last 20 years. Out of 132 relevant articles, 47 articles were included in the final review. We have reviewed existing literature and guidelines and have attempted to provide a few suggestions toward a uniform nomenclature for the various anatomical descriptions and the extent of PLND done while doing a radical cystectomy. The results of another large RCT (SWOG S1011) are awaited and until we have a definitive evidence, we should adhere to these suggestions as much as possible and deal with each patient on a case to case basis.

BACKGROUND/AIM The purpose of this study was to evaluate the learning curve of robotic hysterectomy and pelvic lymphadenectomy for early-stage endometrial carcinoma. PATIENTS AND METHODS A retrospective chart review was performed on the first 81 surgeries performed by a single surgeon. The 81 cases were divided into three groups; 4 subgroups of 20 cases each, 3 subgroups of 27 cases each, and 2 subgroups of 40 cases each. The surgical outcomes in each group were analyzed, using operative time, estimated blood loss, and the number of lymph nodes resected. RESULTS The median operating time, estimated blood loss, and number of pelvic lymph nodes were 147 min, 50 g and 23, respectively. The estimated blood loss improved over time significantly, when dividing by every 27 and 40 cases. No statistical significance was shown regarding operative time and the number of lymph nodes. CONCLUSION Approximately, 30 cases were needed to gain proficiency in the surgical technique.

There is currently no consensus among pathologists on the optimal method of sampling pelvic lympadenectomy specimens (PLND) in prostate cancer. We evaluated the impact of complete PLND submission on lymph node (LN) yield, detection of metastasis and laboratory workload in a series of 141 cases. Following isolation of grossly identifiable LNs/potential LNs, the remaining fatty tissue was embedded in toto. Complete PLND submission increased median LN yield from 10 (1–42) to 17 (3–57). Metastatic deposits were identified in nine non-palpable LNs, which altered the pN category in four cases (3%). The primary tumour (pT) was grade group ≥3 and/or pT3 at radical prostatectomy in 96% of pN+ cases. A median of seven additional blocks (1–28) was required for complete tissue embedding. Our findings indicate that submission of the entire fat can optimise PLND assessment but has a significant impact on laboratory workload. Complete submission of selected high-risk cases may be a reasonable alternative.

The Silva system is a pattern-based classification system that stratifies endocervical adenocarcinomas (AC) into 3 categories to assess the risk of lymph node (LN) metastasis. This study aimed to evaluate whether this novel risk stratification system is applicable to all endocervical AC, including usual and variant, and to suggest a suitable management plan for cervical AC. We retrospectively retrieved consecutive pathology cases with a final diagnosis of endocervical AC treated via radical hysterectomy and pelvic lymphadenectomy. Specimens were classified by consensus according to the Silva system based on “pattern of invasion” as A, B, or C, further clinical/pathologic features were assessed according to pattern-based classification. A total of 76 cases of invasive cervical AC were evaluated. Of these, 63 (82.9%) were categorized as usual-type endocervical AC and 13 (17.1%) as special types. Among those with usual and variants, all patients with pattern A tumor had no LN metastasis and did not develop recurrence. Likewise, multivariate analysis revealed that LN metastasis and pattern C or B tumors are significant independent predictors of disease-free survival (DFS). Although pattern A tumors had no LN metastasis, they also developed complications after surgery, similar to pattern B or C tumors. Regardless of histologic subtypes, pattern A tumors had no LN metastasis and no recurrence. Thus, the Silva classification system can influence the clinical management of all types of endocervical AC. Conservative management is reasonable in all patients with endocervical AC with pattern A tumors.

Aim Radical trachelectomy (RT) with pelvic lymphadenectomy has become an option for young patients with early invasive uterine cervical cancer who decide to maintain their fertility. However, this operative method entails a high risk for the following pregnancy due to its radicality. Therefore, RT for pregnant patients can be a challenge both for gynecologic oncologists and obstetricians. Methods We have performed vaginal RT for five pregnant patients with uterine cervical cancer stage 1B1 according to the method of Dargent et al. The operations were performed between 16 and 26 weeks of pregnancy, and the patients were followed up carefully according to the follow-up methods we reported previously. Results Vaginal RT was performed for five patients without any troubles. Four of the patients continued their pregnancies until almost 34 weeks or longer under our previously published follow-up schedule. The pregnancy of one patient was terminated at 26 weeks due to recurrence of the cancer. Conclusion Expansion of vaginal RT for pregnant patients with uterine cervical cancer could be a practical option for pregnant patients with early invasive uterine cervical cancer.

Robotic pelvic lymphadenectomy (rPLND) has been demonstrated to be a safe and effective minimally invasive approach for patients with metastatic melanoma to the iliac nodes. However, the long-term oncologic benefit of this procedure remains poorly defined. A single-institutional study comparing perioperative outcomes and survival [recurrence-free (RFS) and overall survival (OS)] between rPLND and open PLND (oPLND) for metastatic melanoma was conducted. From 2006 to 2018, a total of 63 PLND cases were identified: 22 rPLND and 41 oPLND. Evidence of isolated pelvic metastasis was the most common indication for PLND in both groups (rPLND: 64%, oPLND: 85%). There was no difference in median pelvic lymph node yield (11 vs. 9 nodes, p = 0.65). Neither treatment group experienced a Clavien-Dindo complication ≥ 3. rPLND was associated with a shorter length of stay compared with oPLND (2 vs. 4 days, p

Lymphocele formation is the most common adverse event of pelvic lymphadenectomy during radical prostatectomy for prostate cancer. Previous studies failed to favor one surgical technique over the other in terms of minimizing its rate. Data on risk factors for its development are still conflicting and warranting further research. In this mini-review, we aimed to scrutinize available evidence on these aspects and outline current achievements in lymphocele prevention approaches.

Lymph node dissection is part of the standard treatment protocol for various cancers, but its role in prostate cancer has been debatable for some time. Pelvic lymphadenectomy has been shown to better help stage prostate cancer patients, but has yet to be definitively proven to be of any benefit for survival. Various templates for lymph node dissections exist, and though some national guidelines have endorsed an extended pelvic node dissection, the choice of template is still controversial. Pelvic lymphadenectomy may lead to a slightly higher rate complications and operative time, and their use must be judiciously applied to patients with a high enough risk of lymph node involvement. We present a comprehensive review of the literature regarding the benefits and harms of lymph node dissection in prostate cancer.

BACKGROUND The purpose of this study was to determine the learning curve of laparoscopic surgery for the treatment of early endometrial cancer and report the surgical outcomes. METHODS Patients: Data were retrospectively extracted from the medical charts of patients who underwent laparoscopic surgery. INTERVENTION Laparoscopic surgery, including pelvic lymphadenectomy, was performed using the same technique and instruments for all patients. OUTCOMES The learning curve for the surgical technique, characterized by the operative time, number of lymph nodes removed, and volume of intra-operative blood loss, was analyzed. RESULTS Over the period of observation, 82 patients were enrolled. For analysis, cases were classified into four groups, based on their surgery date. Between-group comparisons identified a significant decrease in operative time and volume of blood loss between Groups 1 and 4 (P < 0.05). However, the number of lymph nodes removed, and the length of hospital stay were not influenced by learning. CONCLUSION The operative time and the amount of blood loss significantly decreased with an increase in the surgeon's experience but with no effect of learning on the number of lymph nodes removed and length of hospital stay.

Background: High risk upper tract urothelial carcinoma (UTUC) is typically managed with radical nephroureterectomy, however, renal preservation can be attempted when UTUC is localized to the distal ureter in the presence of chronic kidney disease (1–3). Distal ureterectomy is typically managed with a ureteral reimplantation and psoas hitch in order to maintain urothelial continuity, to avoid comprising the contralateral ureter, and reducing risk of chronic urinary tract infections and electrolyte abnormalities (4). We present our case of distal ureteral UTUC managed robotically with a distal ureterectomy with ureteral reimplantation. Technique and Follow-Up: Initially, an Orandi needle on a resectoscope circumscribed the left ureteral orifice. Next, robotically, the retroperitoneum was exposed and a left sided pelvic lymphadenectomy was completed. The left ureter was mobilized and the diseased ureteral segment was transected. The mobilized bladder was sutured to psoas fascia. After a cystotomy, the ureter was re-anastomosed to the bladder. The patient was discharged on postoperative day three and re-evaluated one week later with a cystogram. Final pathology was downgraded to non-invasive low-grade papillary urothelial carcinoma with negative lymph nodes and margins. Conclusion: High risk UTUC localized to the distal ureter in the setting of chronic kidney disease can be managed with a distal ureterectomy (3). Robotic distal ureterectomy with ureteral reimplantation can be assisted by an Orandi needle to achieve negative margins. Utilizing a robotic technique can offer challenges with the ureteral spatulation and reanastomosis (5–7). By fixating the ureter to the bladder prior to reanastomosis, our technique offers a solution for these difficulties.

The purpose of the studywas to review available data on various techniques for radical trachelectomy, inclusion criteria, advantages and disadvantages.Material and methods.A systematic literature search was conducted in the electronic databases of Medline, Russian Science Citation Index, and Russian State Library in the interval time between 1997 and 2017.Results.To date, only radical trachelectomy has shown its value regarding both aspects of oncologic and reproductive outcomes in patients with invasive cervical cancer. There are currently 5 approaches to radical trachelectomy: transvaginal approach with laparoscopic pelvic lymphadenectomy, abdominal, laparoscopic, robot-assisted and laparoscopic – vaginal approach. Each technique has its advantages and disadvantages.Conclusion.Over the last years, radical trachelectomy has been recognized as a valuable fertility-preserving option for women of child-bearing age with invasive cervical cancer. Radical trachelectomy should be performed by highly skilled surgeons in specialized clinics.

BACKGROUND: Lymphoceles are a common postoperative complication after radical prostatectomy with pelvic lymphadenectomy. Therapeutic options include cannulation and drainage (CD), drainage and instillation (DI), or laparoscopic fenestration (LF). The aim of this study was to investigate the epidemiology of symptomatic lymphoceles (SLC) and evaluate the treatment options. METHODS: We retrospectively analysed all patients who underwent robot-assisted radical prostatectomy (RARP) at our clinic from January 1, 2014 to December 31, 2018. All documented lymphoceles of these patients were recorded and analysed with regard to symptoms, possible infection and the treatment option (or options) chosen. RESULTS: We were able to include all 1,029 patients who underwent RARP in the aforementioned period of time. Of these, 18.1% were diagnosed with a lymphocele either when discharged or when readmitted and 6.9% experienced an SLC requiring treatment. Thirteen-point-seven percent of patients readmitted with SLC showed an accompanying thrombosis. Due to recurring or bilateral SLCs receiving different treatment options for each side, there was a total of 115 SLCs treated. CD was carried out in 102 cases. Twenty-point-six percent of patients were sufficiently treated this way, the rest required further treatment or experienced recurrences not requiring further treatment. DI was carried out in 56 cases. Of those patients, 46.4% were sufficiently treated. LF was carried out in 54 cases (either after CD, or after DI, or primarily). Of those patients, 98.1% were treated sufficiently. LF had a statistically significant higher success rate compared to CD and DI (P

Aims This video aims to demonstrate the technical steps for the lateral pelvic lymph node dissection in advanced rectal cancer. It provides an insight into pelvic side wall anatomy and the complex dissection involved in this operation. Methods This operation was done on a 76-year-old lady with advanced rectal cancer post neoadjuvant chemoradiotherapy with a persistent right pelvic lymph node on MRI scan. She also had a laparoscopic APER following the right lateral pelvic lymphadenectomy in the same operative setting. Results Lateral pelvic lymph node dissection (LPLND) is a technically complex and challenging operation. When performed safely, it has been shown to be feasible after neoadjuvant chemoradiotherapy. Our patient tolerated the procedure well and had an uncomplicated post-operative recovery. Conclusion and key statement Laparoscopic LPLN dissection in advanced rectal cancer has been shown to be safe and feasible even after neoadjuvant chemoradiotherapy.

Background The study aims to evaluate the clinical features and management of postoperative lymphatic leakage (PLL) in patients with cervical cancer who received pelvic lymphadenectomy. Methods This retrospective study screened consecutive patients with cervical cancer (stage Ia2-IIb). Results Among 3427 cases screened, 63 patients (1.8%) were diagnosed with PLL, which manifested as persistent abdominal drainage (42/63, 66.7%), chylous ascites (12/63, 19.0%) or vaginal drainage (9/63, 14.3%). Median time from surgery to onset of PLL was 6 days (range, 4–21 days). All cases resolved in a median 10 days (range, 3–56 days) after conservative treatment; although one case experienced recurrence of vaginal drainage after 26 days, this also resolved after conservative therapy. Multivariate analysis showed that two cycles of neoadjuvant chemotherapy (odds ratio [OR], 3.283; 95% confidence interval [95%CI], 1.289–8.360; P = 0.013), a decrease in hemoglobin level of ≥20 and P = 0.046) or ≥ 30 g/L (OR, 8.467; 95%CI, 1.248–17.426; P = 0.029), and postoperative albumin level ≥ 30 and P = 0.027) or P = 0.012) were associated with PLL. Conclusion Neoadjuvant chemotherapy, postoperative anemia and postoperative hypoproteinemia are risk factors for PLL.

A systematic review relating to muscle invasive bladder cancer and radical cystectomy in the elderly was conducted. This chapter covers prognostic factors in elderly patients, mortality rate in elderly undergoing cystectomy, type of reconstruction in the elderly, open radical cystectomy, national trends in cystectomy figures for the elderly, robotic vs. open radical cystectomy in elderly, extraperitoneal vs. transperitoneal laparoscopic approaches, younger vs. older patients for radical cystectomy, risks and benefits of pelvic lymphadenectomy in the elderly, outcomes in elderly patients, pathology of elderly patients undergoing radical cystectomy, pathology of elderly patients undergoing radical cystectomy, post-operative outcomes in younger and older patients.