Pelvic lymphadenectomy for muscle invasive urothelial carcinoma: extended morbidity for limited benefit?

Lymph node dissection (LND) in muscle invasive urothelial carcinoma in the bladder provides staging and prognostic information to guide further treatment options. It may have a therapeutic role in treating early metastatic disease (1). The anatomical extent of LND is controversial, with contradictory data reported from large retrospective cohorts, while international guidelines and systematic reviews have failed to definitively outline the optimal proximal extent for LND (2-4).