Lack of benefit from extended lymphadenectomy in muscle-invasive bladder cancer

Patients with muscle-invasive bladder cancer (MIBC) typically undergo radical cystectomy with bilateral pelvic lymphadenectomy to achieve local disease control and identify pathological nodal metastases. The optimal extent of lymphadenectomy remains a matter of debate and many centres favour an extended approach, despite a lack of evidence from randomized trials. Now, results from the phase III SWOG S1011 trial demonstrate that standard lymphadenectomy provides similar survival outcomes and is safer than an extended procedure.

Patients with T2–4a N0–1 MIBC requiring radical cystectomy were randomly allocated to undergo standard (n = 300) versus extended (n = 292) bilateral pelvic lymphadenectomy. Standard pelvic lymphadenectomy involved removal of the external and internal iliac and obturator nodes. The extended procedure, in addition, involved removal of the common iliac nodes, node-bearing tissue in the presciatic region and presacral nodes. Surgeries were carried out by 36 surgeons who had performed ≥50 radical cystectomies in the previous 3 years and worked in high-volume centres (≥30 such procedures per year). Disease-free survival (DFS) was the primary end point.