Patients with muscle-invasive bladder cancer (MIBC) typically undergo radical cystectomy with bilateral pelvic lymphadenectomy to achieve local disease control and identify pathological nodal metastases. The optimal extent of lymphadenectomy remains a matter of debate and many centres favour an extended approach, despite a lack of evidence from randomized trials. Now, results from the phase III SWOG S1011 trial demonstrate that standard lymphadenectomy provides similar survival outcomes and is safer than an extended procedure.

Patients with T2–4a N0–1 MIBC requiring radical cystectomy were randomly allocated to undergo standard (n = 300) versus extended (n = 292) bilateral pelvic lymphadenectomy. Standard pelvic lymphadenectomy involved removal of the external and internal iliac and obturator nodes. The extended procedure, in addition, involved removal of the common iliac nodes, node-bearing tissue in the presciatic region and presacral nodes. Surgeries were carried out by 36 surgeons who had performed ≥50 radical cystectomies in the previous 3 years and worked in high-volume centres (≥30 such procedures per year). Disease-free survival (DFS) was the primary end point.

肌层浸润性膀胱癌 （MIBC） 患者通常接受根治性膀胱切除术和双侧盆腔淋巴结清扫术，以实现局部疾病控制并识别病理淋巴结转移。淋巴结清扫术的最佳范围仍然是一个争论的问题，尽管缺乏随机试验的证据，但许多中心赞成扩展方法。现在，III 期 SWOG S1011 试验的结果表明，标准淋巴结清扫术提供相似的生存结果，并且比延长手术更安全。

需要根治性膀胱切除术的 T2-4a N0-1 MIBC 患者被随机分配接受标准 （n = 300） 与扩展 （n = 292） 双侧盆腔淋巴结清扫术。标准的盆腔淋巴结清扫术包括切除髂外和内髂淋巴结和闭孔淋巴结。此外，扩展手术涉及切除髂总淋巴结、坐骨前区的淋巴结承载组织和骶前淋巴结。手术由 36 名外科医生进行，他们在过去 3 年中进行了 ≥50 例根治性膀胱切除术，并在高容量中心工作（每年 ≥30 例此类手术）。无病生存期 （DFS） 是主要终点。