Lymphadenectomy in bladder cancer: What should be the extent?

The extent of Lymh node dissection (LND) during radical cystectomy is a subject of increasing importance with several studies suggesting that an extended LND may improve staging accuracy and outcome. Significant numbers of patients have lymph node metastasis above the boundaries of standard LND. Extended LND yields higher number of lymph nodes which may result in better staging. Various retrospective studies have reported better oncological outcomes with extended LND compared to limited LND. No difference in the mortality and the incidence of lymphocele formation has been found between 'standard' and 'extended' LND. Till we have a well-designed randomized controlled trial to address these issues for level 1 evidence, it is not justified to deny our patients the advantages of 'extended' lymphadenectomy based on the current level of evidence.