The role of pelvic lymph node dissection during radical cystectomy for bladder cancer

Radical cystectomy is the standard treatment for patients with invasive bladder cancer. Many aspects regarding the role of concomitant pelvic lymph node dissection (PLND), its extension and the oncological impact are still under discussion.

A detailed literature review is presented to assess the impact of pelvic lymph node dissection during radical cystectomy in terms of staging and therapeutic procedure. Analysis of evidence: The study presented the role of imaging in the assessment of lymph node status, the anatomical account of bladder lymphatic drainage and the techniques for dissection. The evidence from the literature examined showed that pathological stage of the bladder, the extent of PLND in both node-negative and - positive disease, the lymph node density and the extracapsular involvement of metastatic lymph nodes are significant independent prognostic factors for disease-free survival.

Radical cystectomy with bilateral pelvic iliac lymphadenectomy is a standard treatment for high-grade, invasive bladder cancer, providing the best survival outcomes and the lowest local recurrence rates. Even if the precise extent of lymph node dissection is still not standardized, many studies support a more extended lymphadenectomy to obtain better cancer-specific survival rates without significantly increasing the morbidity or mortality of the surgery. The concept of lymph node density may become a useful prognostic variable in high-risk node-positive patients.