Background/Objectives: Pelvic lymph node dissection during radical cystectomy has been established to be important for staging and therapeutic purposes. However, there is uncertainty regarding the optimal extent of nodal dissection. This study aimed to assess the impact of an extended pelvic lymphadenectomy template compared to a standard template in patients with bladder cancer undergoing radical cystectomy. Methods: We performed a systematic review and meta-analysis of randomised studies comparing extended pelvic lymph node dissection to standard pelvic lymph node dissection in patients undergoing radical cystectomy. A search of multiple databases was performed up to October 2024. The standard template was defined as including at least the obturator and internal and external iliac nodes. An extended template was defined as a standard template plus the removal of proximal nodal packets. The primary outcomes were overall survival and major Clavien–Dindo complications. Results: Two studies encompassing a total of 933 participants met the eligibility criteria. There was no observed improvement in overall survival with extended lymph node dissection compared to limited dissection [HR 0.95, 95%CI 0.66–1.4]. In addition, extended lymph node dissection was associated with an increased risk of grade ≥3 Clavien–Dindo complications compared to limited nodal dissection [RR 1.2, 95%CI 1.02–1.37]. There was also an increased risk of lymphoceles requiring intervention with extended lymphadenectomy. Conclusions: Extended pelvic lymphadenectomy does not improve oncological outcomes and is associated with increased morbidity compared to a standard template in bladder cancer patients undergoing radical cystectomy.

We present a case of haemobilia as a primary presentation for underlying cholangiocarcinoma. A man in his 50s initially presented to emergency with Quincke’s triad, RUQ pain, jaundice and UGI bleeding. The initial diagnosis of haemobilia was made on endoscopic retrograde cholangiopancreatography (ERCP) on primary presentation, but the presence of blood and the recurrent clot obstruction of the biliary tract made the underlying diagnosis extremely difficult, resulting in the patient having 4 ERCP, 1 spyglass and multiple CTs and magnetic resonance cholangiopancreatography. Eventually, the patient underwent a Whipple’s procedure without tissue diagnosis, confirming cholangiocarcinoma on histopathology. This case emphasises the difficulty of diagnosis of underlying malignancy in the setting of haemobilia, the benefit of multidisciplinary meeting discussions to support significant interventions and the need to be cautious and curious when managing atypical presentations.