Lymph node dissection in bladder cancer: Where do we stand?

Radical cystectomy with lymphadenectomy remains the standard-of-care treatment for muscle-invasive bladder cancer. Lymphadenectomy is a central component of the operation because it continues to play both diagnostic and therapeutic roles. Routinely available preoperative imaging has limited diagnostic accuracy as it relies mostly on size to identify nodal metastasis increasing the value of lymphadenectomy. While the merits of lymphadenectomy are not in question, the extent of lymphadenectomy required to provide maximum benefit while limiting morbidity remains controversial. Furthermore, although robotic-assisted surgery has gained popularity in many centers, concern remains regarding the learning curve required and skill needed to replicate the quality of an open lymphadenectomy. Research efforts have been focused on these unresolved issues, and several trials are currently ongoing to help address these knowledge deficit areas. In this update, we will focus on the current state of lymphadenectomy for bladder cancer and highlight recent advances.