Meticulous extended lymph node dissection up to the mid-upper third of the common iliac vessels appears to provide survival and recurrence outcomes similar to those of a super extended template up to the inferior mesenteric artery. Complete skeletonization in the extended lymph node dissection template is more important than nodal yield. This does not exclude the possibility that certain patient subgroups with suspicious nodes or after neoadjuvant chemotherapy may benefit from more extensive lymph node dissection.

The maximum defect distance suitable for normal tissue formation using acellular grafts that rely on the native cells for tissue regeneration appears to be 0.5 cm. The indications for the use of acellular matrices in tubularized grafts may therefore be limited by the size of the defect to be repaired.

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Objective To evaluate oncological outcome trends over the last three decades in patients after radical cystectomy (RC) and extended pelvic lymph node (LN) dissection. Patients and Methods Retrospective analysis of the University of Southern California (USC) RC cohort of patients (1488 patients) operated with intent to cure from 1980 to 2005 for biopsy confirmed muscle‐invasive urothelial bladder cancer. To focus on outcomes of unexpected (cN0M0) LN‐positive patients, the USC subset was extended with unexpected LN‐positive patients from the University of Berne (UB) (combined subgroup 521 patients). Patients were grouped and compared according to decade of surgery (1980–1989/1990–1999/≥2000). Survival probabilities were calculated with Kaplan–Meier plots, log‐rank tests compared outcomes according to decade of surgery, followed by multivariable verification. Results The 10‐year recurrence‐free survival was 78–80% in patients with organ‐confined, LN‐negative disease, 53–60% in patients with extravesical, yet LN‐negative disease and ≈30% in LN‐positive patients. Although the number of patients receiving systemic chemotherapy increased, no survival improvement was noted in either the entire USC cohort, or in the combined LN‐positive USC‐UB cohort. In contrast, patient age at surgery increased progressively, suggesting a relative survival benefit. Conclusions Radical surgery remains the mainstay of therapy for muscle‐invasive bladder cancer. Yet, our study reveals predictable outcomes but no survival improvement in patients undergoing RC over the last three decades. Any future survival improvements are likely to result from more effective systemic treatments and/or earlier detection of the disease.