Utility of lymphadenectomy in bladder cancer: where do we stand?

Abstract

The aim of this review is to provide insight into the current state of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa). The first prospective, multicenter, randomized, phase III trial to assess the therapeutic benefit of extended versus limited LND at the time of radical cystectomy failed to demonstrate relevant improvement with extended LND, but showed that this approach does not increase overall complications. Although contemporary rate of LND during radical cystectomy has increased, it remains suboptimal. Minimally invasive radical cystectomy with LND is feasible in most patients and has similar lymph node yields and complication rates compared with open procedures when performed by experienced surgeons. Overall major complication, readmission and mortality rates do not significantly differ according to extent of LND. Meticulous LND provides both diagnostic and potentially therapeutic benefits in patients with bladder cancer. Results of ongoing trials will provide additional insights regarding the anatomic extent and therapeutic benefit of extended versus standard true pelvic-only LND.