ABSTRACT
Historical perspective and rationale for radical cystectomy and lymphadenectomy Anatomic studies define the external and internal iliac and the obturator as the primary lymphatic drainage sites of the bladder and the common iliac sites as the secondary. In addition, there are lymphatics which drain the trigone and the posterior wall directly to the presacral lymph node.1 Following the identification of the primary and secondary lymphatic drainage basins of the bladder within the pelvis, it remained to be determined whether a therapeutic advantage could be gained through their excision at the time of cystectomy. Experience with a similar radical surgical approach for cervical cancer, in which a therapeutic pelvic lymphadenectomy was combined with a total exenterative procedure, demonstrated not only that it could safely be executed but that it also potentially improved outcome.2
