Between March 1, 1983 and December 31, 1985, 18 of 130 patients (14 per cent) undergoing radical cystectomy had unsuspected metastasis. In 17 patients (94 per cent) only 1 or 2 nodes were involved. The mean size of the involved nodes was 0.81 cm. and the mean size of metastasis was 0.39 cm. In patients with 1 or 2 positive nodes metastasis was not observed above the bifurcation of the common iliac arteries or lateral to the external iliac arteries. In patients in whom the primary bladder tumor was localized clearly to 1 side of the bladder unsuspected metastasis was observed only in ipsilateral lymph nodes. In accordance with these findings, we advocate a restricted pelvic lymphadenectomy in patients in whom gross examination reveals no evidence of nodal metastasis at radical cystectomy.
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