What are the benefits of extended bilateral pelvic lymphadenectomy (PLND) in the treatment of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Extended PLND includes the lymph nodes in the presacral region and those surrounding the common iliac vessels to the level of the aortic bifurcation. For a supra-extended PLND, dissection can be continued to the level of the inferior mesenteric artery. In rare cases, patients with lymph node metastases have “skip lesions” (ie, positive nodes in the extended dissection with negative pelvic lymph nodes).

The additional benefit of an extended PLND is controversial. On the basis of several retrospective studies, some experts believe that an extended dissection provides additional staging information and offers a survival benefit. However, no randomized trials to date have proved that an extended PLND is more beneficial than the standard procedure. In a randomized trial of extended versus limited lymph node dissection performed in Germany, extended node dissection failed to show a significant improvement in recurrence-free, cancer-specific, or overall survival. [119] A Southwestern Oncology Group (SWOG) prospective, randomized trial comparing standard with extended pelvic lymphadenectomy has completed accrural and should report in 2022. [96]


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