No survival difference between super extended and standard lymph node dissection at radical cystectomy: what can we learn from the first prospective randomized phase III trial?

Radical cystectomy (RC) with pelvic lymph node dissection (LND) is the standard of care local treatment for patients with muscle-invasive bladder cancer (MIBC) (≥ pT2) (1,2). Current preoperative staging using computed tomography is suboptimal due to its low sensitivity of only 52.6% for the detection of positive lymph nodes (LNs), which leads to a significant understaging of nodal disease (3). This while approximately 25% of patients undergoing RC with LND for bladder cancer (BC) have positive LNs at pathological examination (4). Importantly, positive LNs are the most important driver of cancer specific mortality in organ confined MIBC (4-6). Ideally, the extent of the LND should be tailored to provide maximal oncological control and optimal staging, while preventing peri-operative complications and long-term morbidity