title: The anatomical limits and oncological benefit of lymphadenectomy in muscle invasive bladder cancer.
abstract: BACKGROUND
  Lymphadenectomy is part of standard treatment for muscle invasive bladder cancer. The objective of this review is to provide an up-to-date review on the available scientific evidence in this field.
  
  
  METHODS
  We conducted a literature review in PubMed of relevant articles up to the present (2016). We found a systematic review published in 2014 that included the comparative studies published up to that year, and we updated the review with new relevant publications since that date.
  The number of lymph nodes is not the best indicator for determining the quality of the lymphadenectomy given that the number can vary depending on numerous factors that depend not only on the surgeon but also on the patient and on the pathologist. The definition of standard anatomical territories and a meticulous extraction of the lymph nodes in these territories are more reproducible than the numbers of nodes removed. The optimal extension of lymphadenectomy is a topic of debate. The evidence published to date indicates that any extension of lymphadenectomy is better than not performing it, although it appears that limited lymphadenectomy is insufficient for the oncological control of the disease and that superextended lymphadenectomy provides no oncological benefit versus extended lymphadenectomy.
  
  
  CONCLUSIONS
  Despite a certain amount of controversy in terms of the optimal extension of lymphadenectomy, performing lymphadenectomy in all cases appears to be recommendable according to the available evidence. Extended lymphadenectomy provides greater oncological benefit than more limited dissections, while more extensive lymphadenectomies are not recommended.
authors: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. Electronic address: aguijarro@fhalcorcon.es.
authors: A
authors: A
authors: Guijarro
authors: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
authors: V
authors: V
authors: Hernández
authors: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
authors: C
authors: C
authors: Llorente
mesh_terms: D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009130:Muscle, Smooth / Q000473:pathology; D009361:Neoplasm Invasiveness; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Cáncer vesical con infiltración de la muscular; Linfadenectomía; Lymph node anatomical territory; Lymphadenectomy; Muscle invasive bladder cancer; Oncological value; Territorios anatómicos ganglionares; Valor oncológico