Title: Lymph node dissection in renal cell carcinoma
Authors: Capitanio, Umberto ×
Becker, Frank
Blute, Michael L
Mulders, Peter
Patard, Jean-Jacques
Russo, Paul
Studer, Urs E
Van Poppel, Hendrik #
Issue Date: Dec-2011
Publisher: Elsevier Science
Series Title: European Urology vol:60 issue:6 pages:1212-1220
Abstract: Context: Although lymphadenectomy (lymph node dissection [LND]) is currently accepted
as the most accurate and reliable staging procedure for the detection of lymph
node invasion (LNI), its therapeutic benefit in renal cell carcinoma (RCC) still remains

Objective: Review the available literature concerning the role of LND in RCC staging and

Evidence acquisition: A Medline search was conducted to identify original articles,review articles, and editorials addressing the role of LND in RCC. Keywords included
kidney neoplasms, renal cell cancer, renal cell carcinoma, kidney cancer, lymphadenectomy,lymph node excision, lymphatic metastases, nephrectomy, imaging, and complications. The articles with the highest level of evidence were identified with the consensus of all of the
collaborative authors and were critically reviewed. This review is the result of an interactive peer-reviewing process by an expert panel of co-authors.

Evidence synthesis: Renal lymphatic drainage is unpredictable. The newer available
imaging techniques are still immature in detecting small lymph node metastases.
Results from the European Organization for Research and Treatment of Cancer trial
30881 showed no benefit in performing LND during surgery for clinically node-negative
RCC, but the results are limited to patients with the lowest risk of developing LNI.
Numerous retrospective series support the hypothesis that LND may be beneficial in
high-risk patients (clinical T3–T4, high Fuhrman grade, presence of sarcomatoid features,
or coagulative tumor necrosis). If enlarged nodes are evident at imaging or
palpable during surgery, LND seems justified at any stage. However, the extent of
the LND remains a matter of controversy.

Conclusions: To date, the available evidence suggests that an extended LND may be
beneficial when technically feasible in patients with locally advanced disease (T3–T4)
and/or unfavorable clinical and pathologic characteristics (high Fuhrman grade, larger
tumors, presence of sarcomatoid features, and/or coagulative tumor necrosis). Although
node-positive patients often harbor distant metastases as well, the majority of retrospective
nonrandomized trials seem to suggest a possible benefit of regional LND even
for this group of patients.
In patients with T1–T2, clinically negative lymph nodes and absence of unfavorable
clinical and pathologic characteristics, regional LND offers limited staging information
and no benefit in terms of decreasing disease recurrence or improving survival.
ISSN: 0302-2838
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Urology Section (-)
× corresponding author
# (joint) last author

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