title: Lymphadenectomy for bladder cancer at the time of radical cystectomy.
abstract: BACKGROUND
  Although the importance of lymphadenectomy during radical cystectomy (RC) in high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa) is well accepted, the optimal extent of lymphadenectomy, number of lymph nodes (LNs) to be retrieved, and prognostic and therapeutic role of lymphadenectomy remain debated issues.
  
  
  OBJECTIVE
  In this review, we summarize the existing data on the value of lymphadenectomy for staging and outcome of BCa patients undergoing RC and lymphadenectomy.
  
  
  METHODS
  A systematic Medline/PubMed literature search of peer-reviewed scientific articles published from 1998 and 2012, concerning the role of lymphadenectomy in BCa patients, was carried out. The terms and permutations used were lymphadenectomy, bladder cancer/carcinoma, urothelial carcinomas, radical cystectomy, lymph node metastasis, lymph node dissection, bladder, recurrence, and survival. Selective older articles were included.
  
  
  RESULTS
  Bilateral pelvic lymphadenectomy is an integral part of RC for BCa. The literature regarding the role of lymphadenectomy in BCa patients in general is retrospective, nonstandardized, and of low-level quality in regard to evidence. Prospective randomized trials designed to define the optimal template of lymphadenectomy and its impact on oncologic outcome are advocated. Some of these studies are ongoing, and their completion and analyses are necessary to resolve controversies.
  
  
  CONCLUSIONS
  Many consistent and concordant observations, although of low level of evidence, document that the extent of lymphadenectomy may influence disease-free survival after RC independent of the status of LNs and the pathologic stage of BCa. Lymphadenectomy standardization at the time of RC to create evidence-based guidelines is essential for further improvement of surgical quality and BCa patient survival.
authors: Department of Urology, University of California, Davis, Medical Center, Sacramento, CA 95817, USA. derya.tilki@ucdmc.ucdavis.edu
authors: Derya
authors: D
authors: Tilki
authors: Maurizio
authors: M
authors: Brausi
authors: Renzo
authors: R
authors: Colombo
authors: Christopher P
authors: CP
authors: Evans
authors: Yves
authors: Y
authors: Fradet
authors: Hans-Martin
authors: HM
authors: Fritsche
authors: Seth P
authors: SP
authors: Lerner
authors: Arthur
authors: A
authors: Sagalowsky
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Bernard H
authors: BH
authors: Bochner
mesh_terms: D015653:Cystectomy / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Bladder cancer; Lymphadenectomy; Systematic review