Bladder Cancer
Bladder cancer is one of the most common cancers in the world. About 81,000 new cases are diagnosed annually in the U.S. alone. While it’s more common in men, it affects thousands of women as well. Most bladder cancers are urothelial carcinomas. If caught early, they can often be treated successfully. However, for patients with muscle-invasive bladder cancer (MIBC)—which means the cancer has spread into the muscle wall of the bladder—the situation becomes more complex.
Current treatment for MIBC usually involves a combination of radical cystectomy (removal of the bladder) and neoadjuvant chemotherapy (chemotherapy given before surgery to shrink the tumor). While this approach has been effective, there’s still debate about the best way to remove lymph nodes during surgery. Should surgeons remove only the nearby nodes (standard lymphadenectomy) or more distant ones as well (extended lymphadenectomy)? This question is important because lymph nodes are often where bladder cancer spreads first and removing them could improve a patient’s outcome. On the other hand, it could also increase the risk of complications.
This new study, published in the New England Journal of Medicine, aims to provide answers about whether an extended lymphadenectomy (removal of more lymph nodes) during radical cystectomy improves outcomes for patients with muscle-invasive bladder cancer (MIBC). This is a critical question for many patients, as bladder cancer is known to spread to lymph nodes, and determining the most effective surgical strategy can influence long-term survival.
In this post, I’ll break down the key findings of this study in a way that’s easy to understand for patients and their families. We’ll look at how this approach to surgery compares to the standard lymphadenectomy, and what this means for those undergoing bladder cancer treatment.
What Was the Study About?
The study compared two types of lymph node surgeries performed during bladder removal (radical cystectomy) for patients with muscle-invasive bladder cancer (MIBC):
- Standard lymphadenectomy: This surgery removes lymph nodes closer to the bladder.
- Extended lymphadenectomy: This procedure involves removing more lymph nodes, including those farther from the bladder, such as nodes near the common iliac and presacral areas.
The idea behind removing more lymph nodes is to improve cancer control by taking out any potential cancer that may have spread. But does it really work? Let’s look at what the researchers found.
Key Findings
After following the patients for an average of 6 years, the study found no significant difference in survival between the two groups.
- Survival Rates: About 63% of patients who had standard lymphadenectomy were alive after 5 years, compared to 59% of those who had the extended surgery. This means that removing more lymph nodes didn’t necessarily lead to longer lives for the patients.
- Recurrence: The study also looked at disease-free survival, or how long patients lived without their cancer coming back. Again, there wasn’t a major difference: about 60% of the standard group and 56% of the extended group remained cancer-free after 5 years.
- Safety Concerns: Importantly, the extended surgery was associated with a higher risk of complications. About 7% of patients in the extended group died within 90 days after surgery, compared to only 2% in the standard group. Serious side effects were also more common in the extended surgery group (54% vs. 44%).
What Does This Mean for Bladder Cancer Patients?
If you or a loved one is facing surgery for muscle-invasive bladder cancer, this study provides important insights. While it might seem like removing more lymph nodes could improve your chances, this research suggests that standard lymphadenectomy is just as effective in terms of survival. It also shows that it comes with fewer risks of serious complications.
For many patients, especially those already dealing with other health conditions, the extra risks of the extended surgery may outweigh the potential benefits. As always, your oncologist and surgical team will consider your unique situation, but it’s good to know that standard lymph node removal is a safe and effective option.
Moving Forward: Treatment Decisions
Bladder cancer treatment is constantly evolving, and ongoing research continues to refine the best approaches. In addition to surgery, many patients will also receive chemotherapy or newer treatments like immunotherapy to further reduce the risk of cancer coming back. Talk to your oncologist about the best plan for your specific type of bladder cancer, and make sure you’re informed about all the available options.
About the author
Dr. Daniel Landau is a distinguished board-certified hematologist/oncologist renowned for his exceptional contributions in the field. With an illustrious career spanning across esteemed institutions like the Orlando Health Cancer Institute and the Medical University of South Carolina, Dr. Landau’s expertise shines in both genitourinary oncology and hematology. .
Engage with Dr. Landau’s expertise and ignite your curiosity on “Ask MedOnCMD” as he invites you to explore the vast landscape of oncology with a fresh outlook.