Oncological outcomes of extended versus standard pelvic lymph node dissection in radical cystectomy: An updated systematic review and meta-analysis.

Authors

Rafael Matos Vieira Gordilho, Nilo Jorge Carvalho Leão Barretto, Rodrigo Barbosa Freire Silvão, Felipe Pereira Garrido Pazos, Pedro Rodrigues Queiroz, Matheus Oliveira Figueiredo, Ricardo Andrade Freitas Souza, João Pedro Gomes da Conceição Oliva, Luma Gabriella Firme Sampaio Góes, Rafael Cintra Rosa Corrêa Oliveira, Lorena Barboza de Sousa, Felipe Pinho, Albuquerque Silva, Leonardo Marques Calazans, Wendel Souza Kruschewsky, Alexandre Azevedo Ziomkowski, Eduardo Deda Mendonça Filho, Gabriel Silva Rocha, Marcos Tobias-Machado, Raphael Brandão Moreira

Published in

BJUI compass. Volume 7. Issue 8. Pages e70257. Epub Aug 02, 2026.

Abstract

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.
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.
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.
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.

PMID:
42548973
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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