Adequate pelvic lymph node dissection during radical cystectomy for muscle-invasive carcinoma urinary bladder: A systematic review and meta-analysis of randomized controlled trials comparing extended and limited lymph node dissection.

Introduction: To compare the efficacy and safety of extended lymph node dissection (eLND) versus standard LND (sLND) in patients with bladder cancer undergoing radical cystectomy, focusing on overall survival (OS), recurrence-free survival (RFS), and complications, including symptomatic lymphoceles.

Materials and methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, MEDLINE, Embase, Scopus, and Cochrane databases for randomized controlled trials (RCTs) comparing eLND and sLND. The primary outcomes were OS and RFS, while secondary outcomes included complications such as lymphoceles, sepsis, and urinary tract infections. Data were extracted independently by two authors, and the risk of bias was assessed using the Cochrane RoB 2 tool.

Results: Two RCTs (Gschwend et al., 2019; Lerner et al., 2024) were included, with a total of 1,015 patients. No significant differences were observed in OS (hazard ratio [HR]: 0.95, 95% confidence interval [CI]: 0.66-1.37) or RFS (HR: 1.00, 95% CI: 0.77-1.29) between the eLND and sLND groups. However, eLND was associated with a significantly higher incidence of symptomatic lymphoceles (risk ratio: 2.21, 95% CI 1.13-4.34) and no other major complications. The risk of publication bias was high due to the limited number of included studies.

Conclusion: While eLND did not show a survival benefit over sLND, it was associated with a higher risk of lymphoceles. eLND may be beneficial in patients with higher-risk disease requiring precise staging, but sLND is a viable and less morbid alternative for most patients.