Should patients undergoing surgery for renal cell carcinoma have a lymph node dissection?

While several retrospective studies have suggested a possible benefit of lymph node dissection (LND) for patients with clinically node-positive renal cell carcinoma (RCC), the value of LND in patients with clinically node-negative RCC has remained uncertain. LND undoubtedly improves the accuracy of staging and provides better prognostic information; however, much debate surrounds the impact of LND on progression-free and overall survival in patients with RCC. Additionally, the question remains as to whether LND at nephrectomy is associated with increased morbidity. The final results of the European Organisation for Research and Treatment of Cancer (EORTC) randomized phase III trial 30881 demonstrate that complete LND at nephrectomy does not affect the survival of patients with clinical N0M0 RCC. Importantly, no increase in morbidity was noted in patients who underwent an extended LND compared with no LND, indicating that the performance of LND is unlikely to increase the risk to the patient.