Bladder cancer is staged as cT2N0M0 (muscle-invasive) on TURBT. During robot-assisted radical cystectomy, standard lymphadenectomy template is performed. Which lymph node dissection template is associated with the highest 5-year survival in muscle-invasive bladder cancer?
- A Limited dissection (obturator fossa only)
- B Extended dissection (up to the aortic bifurcation including common iliac, presacral nodes) ✓
- C Standard dissection (external iliac, internal iliac, obturator)
- D Super-extended dissection (up to the inferior mesenteric artery)
Explanation
Extended pelvic lymph node dissection (ePLND), which includes external iliac, internal iliac, obturator, common iliac, and presacral lymph nodes up to the aortic bifurcation, is associated with superior oncological outcomes compared to limited templates in muscle-invasive bladder cancer. Multiple retrospective series and institutional data suggest extended dissection improves both staging accuracy (higher node count, more accurate pN staging) and 5-year recurrence-free survival by removing micro-metastatic disease in common iliac and presacral territory. The landmark data from USC/Skinner groups showed 5-year recurrence-free survival of ~60% with extended dissection in pN+ disease. Current EAU guidelines recommend extended lymphadenectomy as standard.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.