Potential benefit of lymph node dissection during radical nephrectomy for kidney cancer: A review and critical analysis of current literature
Michele Marchionia*(),Daniele Amparoreb,Igino Andrea Maglia,Riccardo Bertoloc,Umberto Carbonarad,Selcuk Erdeme,Alexandre Ingelsf,Constantijn H.J. Muselaersg,Onder Karah,Marco Mascittia,Tobias Klattei,Maximilian Kriegmairj,Nicola Pavank,Eduard Roussell,Angela Pecorarob,Laura Marandinom,Riccardo Campin,Luigi Schipsa,on behalf of the European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer group
aDepartment of Urology, SS Annunziata Hospital, “G. D’Annunzio” University of Chieti, Chieti, Italy bDivision of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy cDepartment of Urology, San Carlo Di Nancy Hospital, Rome, Italy dDepartment of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy eDivision of Urologic Oncology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey fDepartment of Urology, University Hospital Henri Mondor, APHP, Créteil, France gDepartment of Urology, Radboud University Medical Center, Nijmegen, the Netherlands hDepartment of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey iDepartment of Urology, Royal Bournemouth Hospital, Bournemouth, UK jDepartment of Urology, University Medical Centre Mannheim, Mannheim, Germany kUrology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy lDepartment of Urology, University Hospitals Leuven, Leuven, Belgium mDepartment of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy nUnit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
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.
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