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Extended vs Standard Lymph Node Dissection at the Time of Radical Cystectomy for Bladder Cancer
Jamil Almohtasib1, Emily Scire2, Sumedh Kaul2
1Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Urology
|June 26, 2026
Summary
Extended lymphadenectomy (eLND) at radical cystectomy (RC) for bladder cancer showed no significant survival benefit over standard lymphadenectomy (sLND). Real-world data confirm that eLND does not improve cancer-specific or overall survival in RC patients.
Area of Science:
- Urology
- Oncology
- Surgical Oncology
Background:
- Radical cystectomy (RC) is a primary treatment for bladder cancer.
- The extent of lymphadenectomy (LND) during RC remains debated.
- Previous trials suggest no survival difference between extended LND (eLND) and standard LND (sLND), but real-world evidence is limited.
Purpose of the Study:
- To evaluate the oncologic benefit of eLND versus sLND in bladder cancer patients undergoing RC.
- To emulate the LEA AUO AB 25/02 clinical trial using real-world data.
- To assess the association of LND extent with cancer-specific survival (CSS) and overall survival (OS).
Main Methods:
- Retrospective analysis of SEER-Medicare data (2000-2017).
- Identified patients (66-79 years) with high-grade T1 or cT2-T4a, Nany, M0 urothelial bladder cancer treated with RC and LND.
- Defined sLND (4-11 nodes) and eLND (>12 nodes); propensity score adjustment used to compare outcomes.
Main Results:
- 1,204 patients included: 794 eLND, 410 sLND.
- After propensity score adjustment, eLND was not significantly associated with improved 5-year CSS (68% vs 64%; p=0.14) or OS (56% vs 55%; p=0.06) compared to sLND.
- No significant differences observed across subgroups based on T stage, pN stage, or age.
Conclusions:
- In this observational study emulating the LEA AUO AB 25/02 trial, eLND did not demonstrate improved CSS or OS compared to sLND in patients undergoing RC.
- Real-world data suggest that the extent of lymphadenectomy may not significantly impact survival outcomes for bladder cancer patients treated with RC.