Nodal Involvement in Bladder Cancer

Abstract

There are many controversies about the actual meaning of nodal involvement in bladder cancer and, subsequently, about the real benefit of pelvic lymph node dissection (PLND) in patients with positive nodes at the time of cystectomy. In this article we reviewed the literature about the role of nodal involvement and the impact of positive nodes on the prognosis. The finding of positive nodes after radical cystectomy and PLND makes generally consider bladder cancer as a systemic disease and it is associated with poor prognosis. Therefore many urologists don't perform radical surgery in patients with positive nodes at time of cystectomy. P category, N category, and distant metastases are the most important factors in determining the outcome of patients with bladder cancer with nodal involvment. PLND is necessary for accurate staging in bladder cancer and appears to benefit patients with limited nodal involvement. PLND should be considered as a standard procedure that should be performed in every patient with indication of surgical treatment for TCC of the bladder.