What the study found
Extended pelvic lymph node dissection, which removes more lymph nodes around the pelvis during radical cystectomy, likely improves bladder cancer-specific survival compared with standard dissection. It may make little or no difference to overall survival or recurrence-free survival, and it likely increases severe complications.
Why the authors say this matters
The authors conclude that the findings show a trade-off between possible cancer-specific benefit and a higher risk of serious complications for people undergoing radical cystectomy, which is surgery to remove the bladder. The study suggests this difference may matter when choosing between extended and standard pelvic lymph node dissection.
What the researchers tested
The researchers updated a systematic review of randomized controlled trials comparing extended versus standard pelvic lymph node dissection in people undergoing radical cystectomy for muscle-invasive or treatment-refractory non-muscle-invasive urothelial carcinoma of the bladder. They searched multiple databases, trial registries, and conference proceedings through 24 September 2025, then combined study results with meta-analysis and assessed certainty using GRADE.
What worked and what didn't
Two randomized trials with 993 participants were included. Extended dissection likely improved time to death from bladder cancer, with moderate-certainty evidence, but may have made little or no difference to time to death from any cause or time to recurrence, with low-certainty evidence for those outcomes. It likely increased grade III-V complications and likely had similar rates of grade I-II complications; no studies reported disease-specific quality of life.
What to keep in mind
The evidence came from only two randomized trials, and the certainty was moderate to low for most outcomes, mainly because of imprecision. The available summary does not describe disease-specific quality of life results because none were reported, and the findings apply to the types of bladder cancer and surgery studied here.
Key points
- Two randomized trials with 993 participants compared extended and standard pelvic lymph node dissection during radical cystectomy.
- Extended dissection likely improved bladder cancer-specific survival.
- It may have little or no effect on overall survival or recurrence-free survival.
- Extended dissection likely increased severe postoperative complications.
- Minor complications were likely similar between the two approaches.
- No studies reported disease-specific quality of life.
Disclosure
- Research title:
- Extended lymph node dissection may improve bladder cancer-specific survival
- Authors:
- Chan Ho Lee, Andrew Shepherd, Niranjan Sathianathen, Jun Eul Hwang, Eu Chang Hwang, Myung Ha Kim, Vikram Narayan, Jae Hung Jung, Philipp Dahm
- Institutions:
- Austin Health, Chonnam National University Hwasun Hospital, Chonnam National University Hwasun Hospital, Emory University, Inje University Busan Paik Hospital, Minneapolis VA Health Care System, Royal Adelaide Hospital, The University of Adelaide, University of Minnesota, Yonsei University, Yonsei University
- Publication date:
- 2026-04-23
- OpenAlex record:
- View
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