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Review
. 2022 Jul;9(3):215-226.
doi: 10.1016/j.ajur.2022.03.007. Epub 2022 May 27.

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

Michele Marchioni  1 , Daniele Amparore  2 , Igino Andrea Magli  1 , Riccardo Bertolo  3 , Umberto Carbonara  4 , Selcuk Erdem  5 , Alexandre Ingels  6 , Constantijn H J Muselaers  7 , Onder Kara  8 , Marco Mascitti  1 , Tobias Klatte  9 , Maximilian Kriegmair  10 , Nicola Pavan  11 , Eduard Roussel  12 , Angela Pecoraro  2 , Laura Marandino  13 , Riccardo Campi  14 , Luigi Schips  1 ; European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer group
Affiliations
Review

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

Michele Marchioni et al. Asian J Urol. 2022 Jul.

Abstract

Objective: 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.

Keywords: Lymph node dissection; Radical nephrectomy; Renal cell carcinoma; Salvage lymph node dissection.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of mainly used lymph node dissection templates. (A) Schematic representation of main kidney lymphatic drainage. In blue are the most common lymphatic stations involved in standard lymph node dissection for the right (B) and left kidney (C). In yellow are lymphatic stations involved in extended lymph node dissection for the right (B) and left (C) kidney.
See this image and copyright information in PMC

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