Standard versus extended pelvic lymphadenectomy in patients with bladder cancer: A systematic review and meta-analysis.

Abstract

e16609 Background: Pelvic lymph node dissection (PLND) has been a critical component of radical cystectomy in patients with bladder cancer. Radical surgery with standard PLND improves survival in high-risk non-muscle-invasive and muscle-invasive cases. However, the role of extended PLND in these settings is unclear. Methods: A comprehensive literature search of major bibliographic databases was performed from inception to November 2024. Studies comparing extended or super-extended PLND with standard PLND were identified. Data for clinical outcomes were extracted and pooled estimates were calculated using a random effects model with RevMan 5.4. Results: 11 studies (2 RCTs and 9 observational) were included reporting data for 4,001 patients (standard; 1997, extended/super extended; 2204) who underwent radical cystectomy. The pooled analysis demonstrated that extended PLND was associated with significantly better recurrence-free survival (RFS) (HR = 0.67, 95% CI: 0.60-0.74). Standard PLND led to significantly higher 5-year recurrence rates (RR = 1.44, 95% CI: 1.28-1.62) compared to the extended approach. The pooled estimates for disease-specific survival (HR = 0.86, 95% CI: 0.62-1.19), overall survival (OS) (HR = 0.99, 95% CI: 0.86-1.16), and complications remained comparable. Conclusions: Extended PLND improves recurrence-free survival and lowers recurrence rates compared to standard PLND. However, the current evidence is mainly based on retrospective studies, and additional RCTs are warranted to further delineate the role of extended PLND. Clinical outcomes and pooled estimates. Clinical Outcome HR/RR (95% CI) p-value I2 (%) Disease-specific survival 0.86 (0.62-1.19) 0.36 73 RFS 0.67 (0.60-0.74) <0.00001 18 OS 0.99 (0.86-1.16) 0.94 0 5-year recurrence rates 1.44 (1.28-1.62) <0.00001 0 Early Clavien-Dindo Grade 3-4 complications (30 days) 0.90 (0.63-1.29) 0.57 62 Late Clavien-Dindo Grade 5 complications (90 days) 0.90 (0.77-1.04) 0.14 0 Early mortality (30 days) 0.88 (0.39-1.96) 0.75 0 Late mortality (90 days) 0.98 (0.41-2.37) 0.97 0