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

Introduction In the majority of very high-risk and selected high-risk cases of clinically non-muscle-invasive bladder cancer (NMIBC), radical cystectomy (RC) may be performed. However, the necessity of pelvic lymph node dissection (PLND) in this clinical scenario is debated. The aim of this review was to evaluate how the presence and extent of PLND influence survival outcomes. Materials and methods A systematic literature search was performed on July 6th, 2025, without language or time restrictions. Studies were considered eligible if they compared oncological outcomes between various extents of PLND during RC for NMIBC. The primary endpoint was overall survival (OS); secondary endpoints included cancer-specific survival (CSS) and recurrence-free survival (RFS). Results Nine retrospective studies comprising 20,806 patients were included. Pathological upstaging to muscle-invasive disease was observed in 19.1 %–42.0 % of patients. Seven studies evaluated OS, three CSS, and four RFS. Most studies demonstrated OS benefit associated with PLND, particularly in patients with cT1 tumors. Greater lymph node yield - especially the removal of ≥ 10 or ' 20 nodes - was consistently associated with improved OS. Extended PLND was linked to better CSS and RFS in several studies. However, findings for recurrence-related outcomes were heterogeneous and endpoint definitions varied. Conclusions PLND during RC for clinically NMIBC may be associated with improved survival, especially in patients with cT1 disease. Higher lymph node yield may further enhance oncologic benefit. These findings support the consideration of at least limited PLND during RC for clinically NMIBC. Prospective randomized studies are needed to establish definitive recommendations.