What the study found
Extended pelvic lymph node dissection (PLND, removal of lymph nodes in the pelvis) during radical cystectomy may improve bladder cancer-specific survival compared with standard PLND. 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 oncologic benefit and a higher risk of serious complications in people undergoing radical cystectomy for urothelial carcinoma of the bladder. The study suggests this information matters for weighing extended PLND against standard PLND.
What the researchers tested
The researchers conducted an updated systematic review of randomized controlled trials comparing extended PLND with standard PLND in people having 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, and combined trial results with meta-analysis using a random-effects model.
What worked and what didn't
Two randomized controlled trials with 993 participants were included. Extended PLND likely improved time to death from bladder cancer, but may have made little or no difference to time to death from any cause or time to recurrence. It likely increased grade III-V complications and likely resulted in similar grade I-II complications; no studies reported disease-specific quality of life.
What to keep in mind
The certainty of evidence was mostly moderate to low, often because of imprecision. The available summary includes only two trials, and disease-specific quality of life was not reported.
Key points
- Extended PLND may improve bladder cancer-specific survival compared with standard PLND.
- Extended PLND may make little or no difference to overall survival or recurrence-free survival.
- Extended PLND likely increases severe complications within 90 days after surgery.
- Minor complications were likely similar between extended and standard PLND.
- Only two randomized trials with 993 participants were included.
- No studies reported disease-specific quality of life.
Disclosure
- Research title:
- Extended lymph node dissection may improve bladder cancer-specific survival
- Image credit:
- Photo by Tara Winstead on Pexels
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