Should patients with muscle-invasive bladder cancer undergo more-extensive pelvic lymph node dissection?

Abstract

This Practice Point commentary discusses the paper by Dhar and colleagues, which compared outcomes between two cohorts of patients with muscle-invasive bladder cancer who received either 'limited' pelvic lymph node dissection (LND) or 'extended' pelvic LND at clinics in the US or Switzerland. The patients who received extended LND demonstrated improved overall and recurrence-free survival. Notably, however, the 'extended' and 'limited' dissections utilized in this study do not correspond to the commonly used anatomical templates defined by these terms. Nonetheless, despite this and other methodological limitations, this study does add to the growing evidence supporting the use of more-extensive pelvic LND in this setting. One prospective, randomized trial aiming to address this issue is currently accruing patients in Germany. While results are awaited, extended LND should be regarded as an essential component of radical cystectomy and applied to all patients undergoing radical surgery for bladder cancer.