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

Abstract

Objective

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.

Methods

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.

Results

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; I² = 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.

Conclusion

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.