Impact of Pelvic Lymph Node Dissection on Oncological Outcomes in Patients with Clinically Staged Non-Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy: A Systematic Review

According to current guidelines, an upfront Radical Cystectomy (RC) is a valid path for selected patients with high-risk or very high-risk non-muscle-invasive bladder cancer (NMIBC). However, while pelvic lymph node dissection (PLND) is the standard of care for muscle-invasive disease, its role in NMIBC remains a point of debate. This is largely because these patients are generally presumed to have organ-confined disease without nodal involvement.

To bridge this gap, a systematic review published in Critical Reviews in Oncology/Hematology (2026) evaluated oncological outcomes in NMIBC patients undergoing RC plus PLND. Since randomized controlled trials are still lacking, our current evidence relies on retrospective series and administrative databases—both of which have their own methodological hurdles. Consequently, the true value and ideal extent of PLND in this specific population aren't yet fully defined.¹

Key Findings from the Review

The studies analyzed primarily involved male patients (79.5%) with a median age between 67 and 79 years. While the extent of PLND varied, a few clear trends emerged.

Regarding survival benefits, the data suggest that performing PLND is associated with meaningful oncologic gains, including better overall survival (OS) and cancer-specific survival (CSS).

Further, most studies reported a significant survival benefit for those undergoing PLND, though this advantage appeared mostly limited to patients with T1 tumors.

Last but not least, studies suggest that dissecting more than 10 lymph nodes was linked to improved 5-year OS. Interestingly, removing more than 20 nodes was associated with even further improvements in survival.

Why is PLND relevant in NMIBC?

If NMIBC is technically "organ-confined," why does PLND make such a difference? The evidence shows that positive lymph nodes are found in a substantial number of cases. This highlights a significant risk of occult (hidden) muscle-invasive disease, particularly in cT1 tumors. In this light, PLND isn't just a staging tool—it's a therapeutic intervention.

Moving Toward an Individualized Approach

Despite these benefits, the literature remains somewhat contradictory. We have to balance the oncological gains against the fact that extended PLND leads to longer operative times and a higher risk of complications like vascular injury or lymphocele.

Ultimately, the goal is to move toward a more risk-adapted approach. Advances in MRI-based protocols and molecular markers will likely help us identify exactly which patients stand to benefit most from PLND, while sparing others from unnecessary surgical risks.

Written by: Francesco Del Giudice,^1,2 Benjamin I. Chung²

Department of Maternal, Infant and Urologic Sciences, “Sapienza” University of Rome, Rome, ITA
Department of Urology, Stanford University School of Medicine, Stanford, CA, USA

References:

Abu-Ghanem Y, Łaszkiewicz J, Chan HT, et al. Impact of pelvic lymph node dissection on oncological outcomes in patients with clinically staged non-muscle-invasive bladder cancer undergoing radical cystectomy: A systematic review. Crit Rev Oncol Hematol. 2026 Feb 6;220:105192. doi:10.1016/j.critrevonc.2026.105192. Epub ahead of print. PMID: 41655753.

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