Discover the cutting-edge comparison between Thulium fiber laser and Holmium:YAG laser technologies in lithotripsy, revolutionizing the approach to kidney stone treatment.
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Impact of lymph node dissection on surgical and oncological outcomes in patients undergoing robot-assisted radical cystectomy for bladder cancer: a multicenter retrospective study.
Sasaki et al., J Robot Surg 2024
<!– DOI: 10.1007/s11701-024-01893-y //–>
https://doi.org/10.1007/s11701-024-01893-y
Oh, gather round, folks, for a tale of medical intrigue and robotic wizardry at Tokushima University Hospital, where the brave souls embarked on a quest to uncover the mystical powers of lymph node dissection (LND) during robot-assisted radical cystectomy (RARC). Between the years of 2014 and 2021, 216 patients were part of this grand experiment, diving into the depths of surgery to see if more is indeed merrier when it comes to lymph node yield (LNY).
In one corner, we had the heavyweight champions, 115 patients boasting an LNY of ≥20, flexing their surgical outcomes. In the opposite corner, the underdogs, 101 patients with an LNY of <20, ready to prove their worth. The battle was on to see whose survival party would last longer, with tickets to the Overall Survival (OS), Cancer-Specific Survival (CSS), and Recurrence-Free Survival (RFS) shows up for grabs.
But lo and behold, the plot twist no one saw coming: the survival rates between the two groups were virtually identical. That’s right, whether you had more or fewer lymph nodes plucked didn’t seem to make a difference to the grand survival outcomes (OS p=0.256, CSS p=0.791, RFS p=0.953). However, having more lymph nodes removed did score you higher on the lymph node positivity rate, a dubious honor at best (p=0.020).
And what about the extent of LND, you ask? Did going the extra mile with standard vs. extended dissection make a difference? Spoiler alert: it did not. The survival rates were like mirror images, reflecting the same indifferent fate regardless of how far the surgeons ventured (OS p=0.366, CSS p=0.814, RFS p=0.689).
So, what have we learned from this epic saga? In the grand scheme of things, the number and extent of lymph nodes you bid farewell to during RARC might not sway your oncological outcomes. But hey, on the bright side, it does play a starring role in the diagnostic drama, especially with the advent of adjuvant therapy starring immune checkpoint inhibitors. Because, as we all know, in the world of medicine, every bit of information is a piece of the puzzle. And sometimes, it’s not about the survival rates but about knowing your enemy a little better.
In conclusion, while the quest for the holy grail of LND during RARC continues, let’s not forget the diagnostic treasures unearthed along the way. After all, in the grand theater of surgery, every act contributes to the final curtain call.