Lymphadenectomy with radical cystectomy at an Australian tertiary referral institution: time trends and impact on oncological outcomes Renu Eapen,* Mun Sem Liew,†‡ Ali Tafreshi,‡ Nathan Papa,* Nathan Lawrentschuk,*†§ Arun Azad,‡ Ian D. Davis,†‡§¶ Damien Bolton*†§ and Shomik Sengupta*†§ *Department of Urology, Austin Health, Melbourne, Victoria, Australia †Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia ‡Joint Austin-Ludwig Oncology Unit, Austin Health, Melbourne, Victoria, Australia §Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia and ¶Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia Key words bladder cancer, lymphadenectomy, recurrence, survival, time trend. Correspondence Dr Shomik Sengupta, FRACP, 292 Springvale Road, Glen Waverley, Melbourne, Vic. 3150, Australia. Email: senguptaurology@gmail.com R. Eapen FRACS; M. S. Liew FRACP; A. Tafreshi FRACP; N. Papa MBBS; N. Lawrentschuk FRACS, PhD; A. Azad FRACP, PhD; I. D. Davis FRACP, PhD; D. Bolton FRACS, MD; S. Sengupta FRACS, MS. Accepted for publication 9 June 2014. doi: 10.1111/ans.12772 Abstract Background: Lymph node dissection (LND) with radical cystectomy (RC) for sur- gical treatment of invasive urothelial carcinoma of the bladder can improve staging and has possible therapeutic benefit. The aim of this study was to assess utilization and extent of LND with RC at our institution and determine its impact on oncological outcomes. Methods: Using surgical databases and hospital coding, clinical and histopa- thological characteristics of 87 patients who underwent RC at Austin Health between 2004 and 2011 were retrospectively analysed. Associations of predictor variables with LND use and lymph node (LN) status were analysed using logistic regression. Survival analyses were undertaken using Cox proportional hazard models. Results: Fifty-eight (65.9%) patients underwent LND, with a clear trend over time in the proportion of patients undergoing LND (three of seven in 2004 up to 10 of 10 in 2011, P < 0.001) and the median (range) of LN yield from five (2–19) in 2004 to 18 (7–35) in 2011 (P < 0.001). Year of treatment was the only significant predictor (univariately and multivariately) of a patient undergoing LND. Multivariately, a sig- nificant association with nodal metastases was found for cN stage and planned extent of LND preoperatively, and pT stage postoperatively. LN status was associated sig- nificantly with recurrence-free survival with best outcomes in patients who were node-negative on a pelvic LND. A similar trend was seen for cancer-specific survival (P = 0.053). Conclusions: Over the study period, there was an increase in the use of pelvic LND and LN numbers retrieved during RC. LN status appears to impact on recurrence-free survival, and possibly cancer-specific survival. Introduction Curative surgery for invasive urothelial carcinoma (UC) of the bladder usually entails radical cystectomy (RC) in conjunction with lymph node dissection (LND). 1,2 The LND allows accurate nodal staging and thus, consideration of adjuvant chemotherapy for high- risk patients, which may improve disease-specific outcomes and survival. 3 In those patients with disease limited to resected lymph nodes (LN), the LND itself may have therapeutic utility. 4,5 Thus, many experts recommend an extended LND, at least up to the common iliac vessels, at the time of RC. 6,7 However, there remains substantial uncertainty regarding the role and extent of LND during RC, 8,9 and Australian practice patterns are poorly documented. 10 The aim of this study was to assess the utili- zation and adequacy of LND with RC at our institution and deter- mine its impact on oncological outcomes. Methods A retrospective cohort study of patients treated with RC for UC bladder at Austin Health from 1 January 2004 to 31 December 2011 was undertaken with approval from the Austin Health Human ORIGINAL ARTICLE ANZJSurg.com © 2014 Royal Australasian College of Surgeons ANZ J Surg •• (2014) ••–••