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.
Recent literature (from January 2011 to December 2021) was assessed through PubMed and MEDLINE databases. A narrative review of most relevant articles was provided.
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.
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.
Asian journal of urology. 2022 May 27 [Epub]
Michele Marchioni, Daniele Amparore, Igino Andrea Magli, Riccardo Bertolo, Umberto Carbonara, Selcuk Erdem, Alexandre Ingels, Constantijn H J Muselaers, Onder Kara, Marco Mascitti, Tobias Klatte, Maximilian Kriegmair, Nicola Pavan, Eduard Roussel, Angela Pecoraro, Laura Marandino, Riccardo Campi, Luigi Schips, European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer group
Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy., Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy., Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy., Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., Division of Urologic Oncology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey., Department of Urology, University Hospital Henri Mondor, APHP, Créteil, France., Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands., Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey., Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK., Department of Urology, University Medical Centre Mannheim, Mannheim, Germany., Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.