[Lymphatic metastases in bladder carcinoma. Is radical cystectomy indicated?]

Bladder carcinomas with lymph node metastases are a systemic disease with a poor long term survival (< 10%). Surgery has no proven impact on patients survival. Outcome depends on the extent of lymph node disease. Surgery combined with systemic chemotherapy is controversially discussed. Neoadjuvant chemotherapy has no proven survival impact. Adjuvant chemotherapy is under investigation in prospective randomized phase III trials. Lymph node metastases are no exclusion criteria for orthotopic bladder replacement. Extended lymph node dissection is not superior to lymph node dissection limited to the fossa obturatoria. Despite excellent long term results of radical cystectomy and lymphadenectomy in selected patients with node positive disease, surgery seems to be an individual approach, without no proven impact on patients survival and quality of life.