Role of pelvic lymph node dissection in bladder cancer: is it better to do more?

Radical cystectomy (RC) is frequently used for the treatment of muscle invasive bladder cancer (MIBC) (1). Typically, this is accompanied by a pelvic lymph node dissection (PLND), which certainly allows for accurate nodal staging (2) and may even have therapeutic effect, especially in those with small volume disease (3). This has to be weighed against the drawbacks of PLND including increased operative time and added risks of surgery. The decision-making on PLND for MIBC is further complicated by a lack of high-level evidence (4).