Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-Analysis
<b>Background/Objectives:</b> Pelvic lymph node dissection during radical cystectomy has been established to be important for staging and therapeutic purposes. However, there is uncertainty regarding the optimal extent of nodal dissection. This study aimed to assess the impact of an exte...
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2025-06-01
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| Series: | Société Internationale d’Urologie Journal |
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| author | Jordan Santucci Peter Stapleton Marlon Perera Nathan Lawrentschuk Declan Murphy Niranjan Sathianathen |
| author_facet | Jordan Santucci Peter Stapleton Marlon Perera Nathan Lawrentschuk Declan Murphy Niranjan Sathianathen |
| author_sort | Jordan Santucci |
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| description | <b>Background/Objectives:</b> Pelvic lymph node dissection during radical cystectomy has been established to be important for staging and therapeutic purposes. However, there is uncertainty regarding the optimal extent of nodal dissection. This study aimed to assess the impact of an extended pelvic lymphadenectomy template compared to a standard template in patients with bladder cancer undergoing radical cystectomy. <b>Methods:</b> We performed a systematic review and meta-analysis of randomised studies comparing extended pelvic lymph node dissection to standard pelvic lymph node dissection in patients undergoing radical cystectomy. A search of multiple databases was performed up to October 2024. The standard template was defined as including at least the obturator and internal and external iliac nodes. An extended template was defined as a standard template plus the removal of proximal nodal packets. The primary outcomes were overall survival and major Clavien–Dindo complications. <b>Results:</b> Two studies encompassing a total of 933 participants met the eligibility criteria. There was no observed improvement in overall survival with extended lymph node dissection compared to limited dissection [HR 0.95, 95%CI 0.66–1.4]. In addition, extended lymph node dissection was associated with an increased risk of grade ≥3 Clavien–Dindo complications compared to limited nodal dissection [RR 1.2, 95%CI 1.02–1.37]. There was also an increased risk of lymphoceles requiring intervention with extended lymphadenectomy. <b>Conclusions:</b> Extended pelvic lymphadenectomy does not improve oncological outcomes and is associated with increased morbidity compared to a standard template in bladder cancer patients undergoing radical cystectomy. |
| format | Article |
| id | doaj-art-817fe89afbf64c32ae080178321b0b4c |
| institution | Kabale University |
| issn | 2563-6499 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Société Internationale d’Urologie Journal |
| spelling | doaj-art-817fe89afbf64c32ae080178321b0b4c2025-08-20T03:27:43ZengMDPI AGSociété Internationale d’Urologie Journal2563-64992025-06-01633710.3390/siuj6030037Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-AnalysisJordan Santucci0Peter Stapleton1Marlon Perera2Nathan Lawrentschuk3Declan Murphy4Niranjan Sathianathen5Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Grattan Street, Parkville, VIC 3010, AustraliaDepartment of Urology, Grampians Health, Ballarat, VIC 3350, AustraliaDivision of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Grattan Street, Parkville, VIC 3010, AustraliaDivision of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Grattan Street, Parkville, VIC 3010, AustraliaDivision of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Grattan Street, Parkville, VIC 3010, AustraliaDivision of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia<b>Background/Objectives:</b> Pelvic lymph node dissection during radical cystectomy has been established to be important for staging and therapeutic purposes. However, there is uncertainty regarding the optimal extent of nodal dissection. This study aimed to assess the impact of an extended pelvic lymphadenectomy template compared to a standard template in patients with bladder cancer undergoing radical cystectomy. <b>Methods:</b> We performed a systematic review and meta-analysis of randomised studies comparing extended pelvic lymph node dissection to standard pelvic lymph node dissection in patients undergoing radical cystectomy. A search of multiple databases was performed up to October 2024. The standard template was defined as including at least the obturator and internal and external iliac nodes. An extended template was defined as a standard template plus the removal of proximal nodal packets. The primary outcomes were overall survival and major Clavien–Dindo complications. <b>Results:</b> Two studies encompassing a total of 933 participants met the eligibility criteria. There was no observed improvement in overall survival with extended lymph node dissection compared to limited dissection [HR 0.95, 95%CI 0.66–1.4]. In addition, extended lymph node dissection was associated with an increased risk of grade ≥3 Clavien–Dindo complications compared to limited nodal dissection [RR 1.2, 95%CI 1.02–1.37]. There was also an increased risk of lymphoceles requiring intervention with extended lymphadenectomy. <b>Conclusions:</b> Extended pelvic lymphadenectomy does not improve oncological outcomes and is associated with increased morbidity compared to a standard template in bladder cancer patients undergoing radical cystectomy.https://www.mdpi.com/2563-6499/6/3/37bladder cancerradical cystectomysystematic reviewlymph node dissection |
| spellingShingle | Jordan Santucci Peter Stapleton Marlon Perera Nathan Lawrentschuk Declan Murphy Niranjan Sathianathen Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-Analysis Société Internationale d’Urologie Journal bladder cancer radical cystectomy systematic review lymph node dissection |
| title | Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-Analysis |
| title_full | Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-Analysis |
| title_fullStr | Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-Analysis |
| title_full_unstemmed | Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-Analysis |
| title_short | Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-Analysis |
| title_sort | extended vs standard pelvic lymph node dissection in bladder cancer patients undergoing radical cystectomy systematic review and meta analysis |
| topic | bladder cancer radical cystectomy systematic review lymph node dissection |
| url | https://www.mdpi.com/2563-6499/6/3/37 |
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