Nodal involvement

Radical cystectomy and bilateral pelvic lymph-node dissection (PLND) has been established as standard treatment for muscle-invasive bladder cancer.1,2 As regards lymph-node involvement, it has clearly been shown that the presence of nodal metastasis is an indication for at least limited systemic tumour spread, and does translate into decreased survival compared to node-negative patients, despite radical surgery. However, recent data indicate that patients with minimal nodal disease and otherwise organ-confined primary bladder tumours do benefit from radical cystectomy and PLND, and that even a proportion of patients with grossly node-positive bladder cancer can be cured by surgery and thorough lymph-node dissection.3-7