Extended pelvic lymph node dissection in muscle invasive bladder cancer Review


Authors: Katims, A. B.; Bochner, B. H.
Review Title: Extended pelvic lymph node dissection in muscle invasive bladder cancer
Abstract: Purpose of reviewBilateral pelvic lymph node dissection (PLND) at the time of radical cystectomy (RC) provides important staging information and oncologic benefit in patients with bladder cancer. The optimal extent of the PLND remains controversial. Our aim is to highlight nodal mapping studies and the data that guides optimization of both staging and oncologic outcomes. We then review contemporary randomized trials studying the extent of PLND.Recent findingsA recent randomized trial (RCT) powered for a 15% improvement in recurrence-free survival (RFS) of extended (e) over limited (l)PLND was completed but failed to identify this large difference in outcome. Concerns over study design limit the ability to interpret the oncologic results. Importantly, ePLND minimally changed surgical morbidity. An ongoing, similar RCT (SWOG S1011) powered to detect a 10% difference in RFS has completed accrual, but no published outcomes are available.SummaryRC and ePLND can provide cure in 33% of LN positive bladder cancer patients. Current data support a 5% improvement in RFS if ePLND is routinely used in MIBC patients. Two randomized trials powered to identify much larger (15 and 10%) improvements in RFS are unlikely to identify such an ambitious benefit by extending the PLND. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: lymph node dissection; study design; muscle invasive bladder cancer
Journal Title: Current Opinion in Urology
Volume: 33
Issue: 4
ISSN: 0963-0643
Publisher: Lippincott Williams & Wilkins  
Date Published: 2023-07-01
Start Page: 252
End Page: 257
Language: English
DOI: 10.1097/mou.0000000000001096
PUBMED: 37021936
PROVIDER: scopus
DOI/URL:
Notes: Review -- MSK corresponding author is Bernard Bochner -- Source: Scopus
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MSK Authors
  1. Bernard Bochner
    468 Bochner
  2. Andrew Barry Katims
    13 Katims