Potential benefit of lymph node dissection during radical nephrectomy for kidney cancer: A review and critical analysis of current literature


Marchioni M., Amparore D., Magli I. A., Bertolo R., Carbonara U., ERDEM S., ...More

Asian Journal of Urology, vol.9, no.3, pp.215-226, 2022 (Scopus) identifier identifier

  • Publication Type: Article / Review
  • Volume: 9 Issue: 3
  • Publication Date: 2022
  • Doi Number: 10.1016/j.ajur.2022.03.007
  • Journal Name: Asian Journal of Urology
  • Journal Indexes: Scopus
  • Page Numbers: pp.215-226
  • Keywords: Lymph node dissection, Radical nephrectomy, Renal cell carcinoma, Salvage lymph node dissection
  • Istanbul University Affiliated: Yes

Abstract

© 2022 Editorial Office of Asian Journal of UrologyObjective: The role of lymph node dissection (LND) is still controversial in patients with renal cell carcinoma undergoing surgery. We aimed to provide a comprehensive review of the literature about the effect of LND on survival, prognosis, surgical outcomes, as well as patient selection and available LND templates. Methods: Recent literature (from January 2011 to December 2021) was assessed through PubMed and MEDLINE databases. A narrative review of most relevant articles was provided. Results: The frequencies in which LNDs are being carried out are decreasing due to an increase in minimally invasive and nephron sparing surgery. Moreover, randomized clinical trials and meta-analyses failed to show any survival advantage of LND versus no LND. However, retrospective studies suggest a survival benefit of LND in high-risk patients (bulky tumors, T3-4 stage, and cN1 patients). Moreover, extended LND might provide important staging information, which could be of interest for adjuvant treatment planning. Conclusion: No level 1 evidence of any survival advantage deriving from LND is currently available in literature. Thus, the role of LND is limited to staging purposes. However, low grade evidence suggests a possible role of LND in high-risk patients. Randomized clinical trials are warranted to corroborate these findings.