The Usefulness of Lymphadenectomy in Bladder Cancer-Current Status

Abstract

The purpose of this review is to present the current status of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa). Despite the growing body of evidence of LND utility at the time of radical cystectomy (RC) in high-risk nonmuscle-invasive and muscle-invasive BCa (MIBC), therapeutic and prognostic value and optimal extent of LND remain unsolved issues. Recently published results of the first prospective, a randomized trial assessing the therapeutic benefit of extended versus limited LND during RC, failed to demonstrate survival improvement with the extended template. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, limiting the possibility of establishing clear recommendations. This indicates the need for robust and adequately powered clinical trials.

Keywords: bladder cancer; lymph node dissection; lymphadenectomy; staging; surgery.

Figure 1

Anatomical range of lymphadenectomy corresponding to the resection level proposed by Leissner et al. (explanatory notes) [42].

Figure 2

Anatomical diagram of lymphadenectomy divided into ranges: (a)—limited, (b)—standard, (c)—extended, and (d)—superextended (explanatory notes in the text); obturator area (yellow), external illiac vessels (green), internal illiac vessels (purple), common illiac vessels (navy), and presacral area (grey).