# Safety and quality of cystectomy and pelvic lymph node dissection after neoadjuvant durvalumab and cisplatin/gemcitabine.

**Tumor:** Cáncer de vejiga músculo-invasivo
**Autores:** Afferi L, Spahn M, Hayoz S et al
**Revista:** BJU Int (2024)
**PMID:** 38456541 | **PMCID:** —
**DOI:** [10.1111/bju.16318](https://doi.org/10.1111/bju.16318)
**Fuente:** PubMed (abstract only)

## Relevancia
Cáncer de vejiga músculo-invasivo (cN+/cN0) tras quimioterapia neoadyuvante basada en cisplatino o inmunoterapia (KEYNOTE-866, EV-302): tasas de ypN0, calidad de PLND y pronóstico. Similar al paradigma mamario: la respuesta ganglionar patológica es un marcador pronóstico clave y la PLND completa sigue siendo esencial incluso con downstaging.

## Abstract
To report on the surgical safety and quality of pelvic lymph node dissection (PLND) in patients treated with radical cystectomy (RC) and PLND for muscle-invasive bladder cancer (MIBC) after neoadjuvant chemo-immunotherapy.

The Swiss Group for Clinical Cancer Research (SAKK) 06/17 was an open-label single-arm phase II trial including 61 cisplatin-fit patients with clinical stage (c)T2-T4a cN0-1 operable urothelial MIBC or upper urinary tract cancer. Patients received neoadjuvant cisplatin/gemcitabine and durvalumab followed by surgery. Prospective quality assessment of surgeries was performed via central review of intraoperative photographs. Postoperative complications were assessed using the Clavien-Dindo Classification. Data were analysed descriptively.

A total of 50 patients received RC and PLND. All patients received neoadjuvant chemo-immunotherapy. The median (interquartile range) number of lymph nodes removed was 29&#x2009;(23-38). No intraoperative complications were registered. Grade &#x2265;III postoperative complications were reported in 12 patients (24%). Complete nodal dissection (100%) was performed at the level of the obturator fossa (bilaterally) and of the left external iliac region; in 49 patients (98%) at the internal iliac region and at the right external iliac region; in 39 (78%) and 38 (76%) patients at the right and left presacral level, respectively.

This study supports the surgical safety of RC and PLND following neoadjuvant chemo-immunotherapy in patients with MIBC. The extent and completeness of protocol-defined PLND varies between patients, highlighting the need to communicate and monitor the surgical template.

## Acceso
Vía [DOI](https://doi.org/10.1111/bju.16318) o suscripción institucional.

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*Datos de PubMed. Citar: doi 10.1111/bju.16318*
