A study published in the New England Journal of Medicine compared standard and extended lymphadenectomy in patients with local muscle-invasive bladder cancer who underwent radical cystectomy.[2] It included 592 eligible patients with stage T2 to T4a urothelial cancer and up to two positive lymph nodes who were randomly assigned to either extended (292 patients) or standard (300 patients) bilateral lymphadenectomy.[1][2] Extended lymphadenectomy involved the removal of lymph nodes in the area of the common iliac, presacral, and presacral nodes.[1][2] The primary endpoint was recurrence-free survival, the secondary was overall survival.[1][2] After a median follow-up of 6.1 years, recurrence or death occurred in 130 patients (45%) in the extended lymphadenectomy group and 127 (42%) in the standard group; estimated 5-year recurrence-free survival was 56% versus 60% (hazard ratio 1.10; 95% CI 0.86–1.40; P=0.45).[2] Five-year overall survival was 59% in the extended group and 63% in the standard group (hazard ratio for death 1.13; 95% CI 0.88–1.45).[2] Grade 3 to 5 serious adverse events occurred in 157 patients (54%) in the extended group versus 132 (44%) in the standard; death within 90 days after surgery was in 19 (7%) versus 7 (2%) patients.[2]