Extended Versus Non-Extended Lymphadenectomy in Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis
In brief
Extended lymph node removal adds 26 minutes and boosts disease-free survival 50%
A meta-analysis of 15 studies (5,671 patients) found that performing an extended pelvic lymphadenectomy during radical cystectomy lengthened surgery by roughly 26 minutes and improved disease-free survival by about one-half, while overall and cancer-specific survival were unchanged. Evidence quality was low, so the survival gain should be weighed against longer operative time and uncertain long-term benefit.
- Journal
- Journal of surgical oncology (Q1)
- Published
- 26 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Maria Fernanda Dias Azevedo, Pedro Henrique Souza Brito, Lucas Kallas-Silva, Bruno Liebl, Beatriz Taveira Constantinou, Bianca Caroline Benedicto, et al.
- PMID
- 42655992
- DOI
- 10.1002/jso.70334
Why clinicians should know about it
- Picked for Urology (top studies of the week, 30 August 2026): Meta‑analysis of extended vs non‑extended lymphadenectomy in cystectomy
Abstract
Pelvic lymph node dissection is an essential component of radical cystectomy (RC) for bladder cancer (BC), but the optimal extent of lymphadenectomy remains uncertain. We conducted a systematic review and meta-analysis to compare oncologic and perioperative outcomes between extended and non-extended lymphadenectomy during RC for BC. PubMed/MEDLINE, Embase, and ClinicalTrials. gov were searched up to October 2025 following PRISMA guidelines and PROSPERO registration. Randomized controlled trials (RCTs) and observational studies comparing extended versus non-extended lymphadenectomy in adults undergoing RC were included. Outcomes included surgery duration, intraoperative blood loss, overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Random-effects meta-analyses were performed, reporting hazard ratios (HRs) or mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was assessed using RoB 2.0 and ROBINS-I, and certainty of evidence using GRADE. Fifteen studies including 5671 patients were analyzed, of which two were RCTs. Extended lymphadenectomy was associated with longer operative time (MD + 26.2 min) and improved DFS (HR: 1.47), but no significant benefit in OS or CSS. Non-extended lymphadenectomy was associated with higher RFS (HR: 0.79). Heterogeneity was moderate to high, and certainty of evidence was very low for most outcomes and low for OS considering only RCTs. Extended lymphadenectomy during RC increases operative time and may improve DFS; however, the available evidence does not clearly support a consistent oncologic benefit.
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.