الفهرس 
Staging laparoscopic lymphadenectomy in high-risk superficial bladder cancer
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Abstract
Background : In Egypt, bladder cancer (BCa) is the 3rd most common cancer and is the 2nd most common malignancy in men after Liver cancer. Approximately 75% of patients with BCa present with non{u2013}muscle invasive bladder cancer (NMIBC). There is significant potential for understaging in patients with high-risk NMIBC, especially T1 HG, up to 50% of patients with T1 are upstaged to muscle-invasive disease at time of RC, and 6{u2013}19% of patients have LNMs. Aim of Work: evaluate the safety and efficacy of upfront Laparoscopic pelvic lymph node dissection (Lap PLND) as an additional staging tool in patients with high-risk NMIBC indicated for radical cystectomy (RC). Patients and Methods: In a prospective study conducted at Theodor Bilharz Research Institute between March 2009 and March 2012, a total of 40 patients with high risk NMIBC indicated for RC underwent upfront laparoscopic pelvic lymphadenectomy (lap PLND) 2 weeks prior to RC. Results: At RC, 22.5% of patients were upstaged to muscle-invasive disease, and 12.5% had LNMs. Within a median follow-up 71 months, disease recurred after RC in 27.5% of patients and 22.5% of patients died of metastatic disease. Lymph node status was the single greatest predictor of disease recurrence and survival. In regard to the efficacy of Lap PLND, no residual LNs were found at the time of RC, median operative time was 56 min, median hospital stay was 1 day, and median number of removed LNs was 13, which is within the ranges reported in the literature. Adverse-effects occurred in 4 patients, and were all minor complications (grade I-II). Conclusion: Lap PLND is a safe and efficient procedure that could improve the accuracy of pre-cystectomy staging