Editing Cystectomy (section)

==== Template ====
* '''<span style="color:#ff0000">Bilateral pelvic lymph node dissection should be performed with removal, at minimum, of the (3)</span>'''
*#'''<span style="color:#ff0000">Obturator lymph nodes</span>'''
*#'''<span style="color:#ff0000">Internal iliac lymph nodes</span>'''
*#'''<span style="color:#ff0000">External iliac lymph nodes</span>'''

===== Boundaries =====
* '''<span style="color:#ff0000">Superiorly: ureter/bifurcation of the common iliac artery</span>'''
* '''<span style="color:#ff0000">Inferiorly: circumflex iliac vein and Cloquet’s node/Cooper ligament at the femoral canal</span>'''
* '''<span style="color:#ff0000">Laterally: genitofemoral nerve</span>'''
* '''<span style="color:#ff0000">Medially: bladder and internal iliac artery</span>'''
* '''<span style="color:#ff0000">Posteriorly: obturator nerve/fossa</span>'''

===== Extended lymph node dissection =====
*Many retrospective studies have suggested a survival benefit of extending the cystectomy lymph node dissection boundaries to a level as high as the inferior mesenteric artery.
*Randomized trials (SWOG S1011 and LEO AUO AB 25/02) suggest no significant benefit (see [[Muscle-Invasive Bladder Cancer|Muscle-Invasive Bladder Cancer Chapter Notes]])

===== <span style="color:#ff0000">Lymph node count</span> =====
* '''<span style="color:#ff0000">To facilitate adequate staging, a standard lymphadenectomy </span>(bilateral external iliac, internal iliac and obturator lymph nodes), <span style="color:#ff0000">at a minimum, needs to be completed with >12 lymph nodes evaluated.</span>[https://www.auanet.org/guidelines/guidelines/bladder-cancer-non-metastatic-muscle-invasive-guideline]'''
*'''Absolute number of nodes removed has been shown to provide important prognostic information and staging accuracy both in lymph node positive and lymph node negative patients'''
** Removing > 10 nodes is recommended ['''AUA MIBC Guidelines say >12'''] based on observational studies evaluating node count and survival