Oncological outcomes of extended versus standard pelvic lymph node dissection in radical cystectomy: An updated systematic review and meta-analysis
In brief
Extended pelvic node dissection fails to improve overall survival in bladder cancer
A meta-analysis of 16 studies (about 6,000 patients) found that removing more pelvic lymph nodes during radical cystectomy did not increase overall survival, despite a modest reduction in cancer recurrence that vanished in randomized trials. Major complication rates were unchanged, suggesting routine use of extended dissection solely for survival benefit is not justified.
- Journal
- BJUI compass (Q1)
- Published
- 2 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Rafael Matos Vieira Gordilho, Nilo Jorge Carvalho Leão Barretto, Rodrigo Barbosa Freire Silvão, Felipe Pereira Garrido Pazos, Pedro Rodrigues Queiroz, Matheus Oliveira Figueiredo, et al.
- PMID
- 42548973
- DOI
- 10.1002/bco2.70257
Why clinicians should know about it
- Picked for Nephrology (top studies of the week, 9 August 2026): Extended pelvic lymph node dissection in bladder cancer, not renal
- Picked for Urology (top studies of the week, 9 August 2026): ePLND vs sPLND meta‑analysis, bladder cancer surgery
Abstract
OBJECTIVE: This study aims to evaluate whether extended lymph node dissection (ePLND) improves overall survival (OS) and oncological outcomes compared with standard dissection (sPLND) in patients undergoing radical cystectomy for urothelial bladder cancer. METHODS: A systematic review and meta-analysis were conducted according to PRISMA 2020 (PROSPERO CRD420261309465). PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. RCTs and observational studies comparing ePLND and sPLND were included. The primary outcome was OS; secondary outcomes included recurrence-free survival (RFS), cancer-specific survival (CSS), 5-year OS, 5-year RFS, major complications and lymphocele. A random-effects model was used, with sensitivity analyses and meta-regression. Risk of bias was assessed using RoB 2 and ROBINS-I. RESULTS: Sixteen studies (n = 5960) were included. ePLND did not significantly improve OS compared with sPLND (HR = 0.86; 95% CI 0.72-1.03; p = 0.09; I 2 = 50%). The overall RFS analysis suggested a benefit favouring ePLND (HR = 0.74; 95% CI 0.63-0.81; p < 0.00001); however, this effect did not persist in analyses restricted to RCTs. No consistent benefit was observed for 5-year OS, although recurrence was reduced. ePLND did not significantly affect major complications. Sensitivity analyses confirmed result stability. CONCLUSION: Higher quality evidence does not demonstrate a consistent benefit of ePLND for OS, although overall analyses show reduced recurrence. Current data do not support the routine adoption of ePLND with the sole objective of improving survival.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.