The management of muscle-invasive transitional cell carcinoma (TCC) of the bladder continues to evolve. The standard treatment for patients presenting with clinical stage T2-4aN0M0 bladder cancer remains radical cystectomy. However, the management of patients who present with more advanced disease on clinical evaluation, such as unresectable pelvic tumor (T4b) or regional pelvic lymph node metastases (N+) remains unclear. In addition, the intraoperative management of unsuspected pelvic adenopathy identified during exploration of a planned radical cystectomy, continues to generate controversy. The following discussion relates to the evolving attitudes towards the role of surgery in the treatment of advanced bladder cancer.