Lymphadenectomy in Muscle Invasive Bladder Cancer

Bladder cancer is the second most common genitourinary malignancy with urothelial cancer comprising nearly 90% of primary bladder tumors. Urothelial carcinoma of the urinary bladder is the fifth most common malignancy in the United States, with an estimated 76,960 new cases and 163,900 deaths in 2016. Radical cystectomy with lymph node dissection remains the standard treatment for patients with muscle-invasive urothelial carcinoma of the bladder, and also for nonmuscle-invasive disease, refractory to intravesical therapy. The current approaches to pelvic lymph node dissections are based on the removal of lymph nodes most commonly harboring metastatic disease, notably the external iliac, obturator, and hypogastric lymph nodes. The boundaries for a standard pelvic lymph node dissection generally include the bifurcation of the common iliac vessels superiorly and the genitofemoral nerve laterally. Extended pelvic lymph node includes the removal of lymph nodes between the bifurcation of the common iliac vessels and the level of the aortic bifurcation, sometimes including distal aortic and caval nodes up to the level of the inferior mesenteric artery, as well as presacral nodes. Extended and superextended dissection has been reported to be associated with superior survival outcome