The anatomic extent and completeness of pelvic lymphadenectomy is what matters

There is an imperative need to improve the cure rates of patients diagnosed with invasive bladder cancer. The lymph node dissection performed at the time of radical cystectomy has an ability to improve locoregional disease control, assign pathologic nodal stage as well as cure some patients with nodal metastases. However, there is a lack of agreement of what constitutes an adequate lymph node dissection at the time of radical cystectomy to optimize oncologic outcomes.

This review challenges the value of lymph node count as a surrogate for a well performed lymphadenectomy. The review also presents recent articles that add to the body of literature suggesting an extended lymph node dissection cures more patients than lesser anatomic templates of lymphadenectomy, including some patients with common iliac lymph node metastases.

A meticulous surgical lymphadenectomy adhering to well defined surgical boundaries provides the best opportunity for cure. Ongoing phase III prospective randomized clinical trials will determine the true benefit of extended lymph node dissection.