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Review
. 2023 Jul 1;33(4):258-268.
doi: 10.1097/MOU.0000000000001097. Epub 2023 Apr 3.

Need for and extent of lymph node dissection for upper tract urothelial carcinoma: an updated review in 2023

Takafumi Yanagisawa  1   2 , Tatsushi Kawada  1   3 , Markus von Deimling  1   4 , Ekaterina Laukhtina  1   5 , Takahiro Kimura  2 , Shahrokh F Shariat  1   6   7   8   9   10
Affiliations
Review

Need for and extent of lymph node dissection for upper tract urothelial carcinoma: an updated review in 2023

Takafumi Yanagisawa et al. Curr Opin Urol. .

Abstract

Purpose of review: Although lymph node dissection (LND) during radical nephroureterectomy (RNU) is recommended for high-risk nonmetastatic upper tract urothelial carcinoma (UTUC), adherence to guidelines remains insufficient in clinical practice. Therefore, this review aims to comprehensively summarize the current evidence regarding the diagnostic, prognostic, and therapeutic impact of LND during RNU in UTUC patients.

Recent findings: Clinical nodal staging using conventional CT scan has low sensitivity (25%) and diagnostic accuracy [area under the curve (AUC): 0.58] in UTUC, suggesting the importance of LND for obtaining accurate N-staging. Patients with pathological node-positive (pN+) disease have poor disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) compared with those with pN0. In addition, population-based studies showed that patients who underwent LND improved CSS and OS than those who did not, even in patients who received adjuvant systemic therapy. The number of lymph nodes removed has also been shown to be associated with improved CSS and OS, even in pT0 patients. Template-based LND should be performed as the extent of lymph node is more important than the number of lymph nodes. Robot-assisted RNU may facilitate performing a meticulous LND compared with a laparoscopic approach. Postoperative complications such as lymphatic and/or chylous leakage are increased but adequately manageable. However, the current evidence is not supported by high-quality studies.

Summary: Based on the published data, LND during RNU is a standard procedure for high-risk nonmetastatic UTUC, owing to its diagnostic, staging, prognostic, and, potentially, therapeutic benefits. Template-based LND should be offered to all patients who are planned for RNU for high-risk nonmetastatic UTUC. Patients with pN+ disease are optimal candidates for adjuvant systemic therapy. Robot-assisted RNU may facilitate meticulous LND compared with laparoscopic RNU.

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Conflict of interest statement

T.K. is a paid consultant/advisor of Astellas, Bayer, Janssen and Sanofi. S.F.S. received as follows: honoraria – Astellas, AstraZeneca, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Roche, Takeda; consulting or advisory role – Astellas, AstraZeneca, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Pierre Fabre, Roche, Takeda; speakers Bureau – Astellas, Astra Zeneca, Bayer, BMS, Ferring, Ipsen, Janssen, MSD, Olympus, Pfizer, Richard Wolf, Roche, Takeda.

Figures

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Box 1
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FIGURE 1
FIGURE 1
Modified anatomical lymph node templates depending on tumor location based on the studies by Kondo et al. and Matin et al. Data from [45,47].
See this image and copyright information in PMC

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References

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