Despite radical surgery invasive urothelial carcinoma has a high risk of systemic progression. In current retrospective trials extensive lymph node dissection and a high number of resected lymph nodes improved the cancer-specific survival in patients undergoing radical cystectomy. Furthermore, extracapsular dissemination of lymph node metastases, lymph node density and absolute number of positive lymph nodes were identified as further risk factors. An innovative approach is the detection of occult bladder tumor cells in histopathologically normal lymph nodes by epithelial markers using the reverse transcriptase polymerase chain reaction (RT-PCR). Long-term observation will be necessary to evaluate the clinical value of molecular-based detectable micrometastases in lymph nodes. The extended lymph node dissection as a new surgical standard for bladder cancer survival is probable but only randomized prospective LEA and SWOG-S1011 trials will provide conclusive new data.     «

Despite radical surgery invasive urothelial carcinoma has a high risk of systemic progression. In current retrospective trials extensive lymph node dissection and a high number of resected lymph nodes improved the cancer-specific survival in patients undergoing radical cystectomy. Furthermore, extracapsular dissemination of lymph node metastases, lymph node density and absolute number of positive lymph nodes were identified as further risk factors. An innovative approach is the detection of occu...     »