The evolving role of pelvic lymphadenectomy in the treatment of bladder cancer

Regional lymphadenectomy is integral to the surgical management of high-grade invasive bladder cancer. A growing body of evidence suggests that a lymph node dissection may provide not only improved prognostic information, but also a clinically significant therapeutic benefit for both lymph node positive and negative patients undergoing radical cystectomy. While the inclusion of lymph node resection in conjunction with radical cystectomy for patients with clinically negative nodes is well accepted, the extent of the nodal dissection remains highly contentious. Similarly, the benefit of node dissection for patients with advanced disease and gross adenopathy or for those with superficial disease (Ta, T1 or TIS) remains a topic of heated debate. This review describes the historical evolution of lymphadenectomy in the surgical treatment of bladder cancer and provides a comprehensive review of the current literature addressing the role of lymph node dissection in the treatment of bladder cancer.