A recent clinical trial has revealed that extended lymphadenectomy, a surgical procedure that involves the removal of more lymph nodes, does not improve disease-free or overall survival rates compared to standard lymphadenectomy in patients with localised muscle-invasive bladder cancer undergoing radical cystectomy.
The study, involving 658 patients with clinical stage T2 to T4a bladder cancer, randomly assigned 592 eligible individuals to undergo either standard or extended lymphadenectomy. The trial, which was conducted across 27 sites in the United States and Canada, aimed to evaluate the effectiveness of the two surgical approaches over a median follow-up period of 6.1 years.
Results showed that 45% of patients in the extended-lymphadenectomy group experienced recurrence or death, compared to 42% in the standard group. The estimated five-year disease-free survival rates were 56% and 60%, respectively, with a hazard ratio of 1.10, indicating no significant difference. Overall survival rates also showed minimal variation, with 59% for the extended group and 63% for the standard group.
Moreover, the study noted higher rates of serious adverse events in the extended lymphadenectomy group, with 54% experiencing grade 3 to 5 complications compared to 44% in the standard group. The findings suggest that while extended lymphadenectomy may seem more aggressive, it does not provide additional survival benefits and carries increased risks, highlighting the need for careful consideration of surgical options in bladder cancer treatment.
Reference
Lerner SP et al. Standard or extended lymphadenectomy for muscle-invasive bladder cancer. N Engl J Med. 2024;391:1206-16.
