CONTEXT: The role of lymph node dissection (LND) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial cancer (UTUC) is still controversial. OBJECTIVE: To analyze the impact of lymph node invasion on the outcome of patients, the staging, and the possible therapeutic role of LND in UTUC. EVIDENCE ACQUISITION: A Medline search was conducted to identify original articles, review articles, and editorials addressing the role of LND in UTUC. Keywords included upper tract urothelial neoplasms, lymphadenectomy, lymph node excision, lymphatic metastases, nephroureterectomy, imaging, and survival. EVIDENCE SYNTHESIS: Regional nodes are frequently involved in UTUC and represent the most common metastatic site. Regional nodal status is a significant predictor of patient outcomes, especially in invasive disease. Therefore, select patients treated with RNU at high risk for regional nodal metastases should undergo LND to improve disease staging, which would identify those who could benefit from adjuvant systemic therapy. Several retrospective studies suggested the potential therapeutic role of LND in UTUC. An accurate LND could remove some nodal micrometastases not identified on routine pathologic examination, thus improving local control and cancer-specific survival. Radical surgery and LND might be curative in a subpopulation with limited nodal disease, as described in bladder cancer. A clear knowledge of the limits of LND and a template of LND for UTUC are still needed. CONCLUSIONS: An extended LND can provide better disease staging and may be curative in patients with limited nodal disease. However, current evidence is based on retrospective studies, which limits the ability to standardize either the indication or the extent of LND. Prospective trials are required to determine the impact of LND on survival in patients with UTUC and identify patients for a risk-adapted approach such as close follow-up or adjuvant chemotherapy.
CONTEXT: The role of lymph node dissection (LND) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial cancer (UTUC) is still controversial. OBJECTIVE: To analyze the impact of lymph node invasion on the outcome of patients, the staging, and the possible therapeutic role of LND in UTUC. EVIDENCE ACQUISITION: A Medline search was conducted to identify original articles, review articles, and editorials addressing the role of LND in UTUC. Keywords included upper tract urothelial neoplasms, lymphadenectomy, lymph node excision, lymphatic metastases, nephroureterectomy, imaging, and survival. EVIDENCE SYNTHESIS: Regional nodes are frequently involved in UTUC and represent the most common metastatic site. Regional nodal status is a significant predictor of patient outcomes, especially in invasive disease. Therefore, select patients treated with RNU at high risk for regional nodal metastases should undergo LND to improve disease staging, which would identify those who could benefit from adjuvant systemic therapy. Several retrospective studies suggested the potential therapeutic role of LND in UTUC. An accurate LND could remove some nodal micrometastases not identified on routine pathologic examination, thus improving local control and cancer-specific survival. Radical surgery and LND might be curative in a subpopulation with limited nodal disease, as described in bladder cancer. A clear knowledge of the limits of LND and a template of LND for UTUC are still needed. CONCLUSIONS: An extended LND can provide better disease staging and may be curative in patients with limited nodal disease. However, current evidence is based on retrospective studies, which limits the ability to standardize either the indication or the extent of LND. Prospective trials are required to determine the impact of LND on survival in patients with UTUC and identify patients for a risk-adapted approach such as close follow-up or adjuvant chemotherapy.
Authors: Mounsif Azizi; Salim K Cheriyan; Charles C Peyton; Beat Foerster; Shahrokh F Shariat; Philippe E Spiess Journal: Curr Treat Options Oncol Date: 2019-04-01
Authors: Bjarte Almås; Stein Øverby; Ole J Halvorsen; Lars A R Reisæter; Jørg Assmus; Birgitte Carlsen; Anders Loe; Christian Beisland Journal: World J Urol Date: 2019-05-23 Impact factor: 4.226
Authors: Evanguelos Xylinas; Luis Kluth; Sibani Mangal; Morgan Roupret; Pierre I Karakiewicz; Shahrokh F Shariat Journal: World J Urol Date: 2012-09-18 Impact factor: 4.226
Authors: Michael Rink; Daniel Sjoberg; Evi Comploj; Vitaly Margulis; Evanguelos Xylinas; Richard K Lee; Jens Hansen; Eugene K Cha; Jay D Raman; Mesut Remzi; Karim Bensalah; Giacomo Novara; Surena F Matin; Felix K Chun; Eiji Kikuchi; Wassim Kassouf; Juan I Martinez-Salamanca; Yair Lotan; Christian Seitz; Armin Pycha; Richard Zigeuner; Pierre I Karakiewicz; Douglas S Scherr; Andrew J Vickers; Shahrokh F Shariat Journal: Ann Surg Oncol Date: 2012-07-18 Impact factor: 5.344
Authors: Meera R Chappidi; Max Kates; Michael H Johnson; Noah M Hahn; Trinity J Bivalacqua; Phillip M Pierorazio Journal: Urol Oncol Date: 2016-07-27 Impact factor: 3.498
Authors: Adil Ouzzane; Pierre Colin; Tarek P Ghoneim; Marc Zerbib; Alexandre De La Taille; François Audenet; Fabien Saint; Nicolas Hoarau; Emilie Adam; Marie Dominique Azemar; Henri Bensadoun; Luc Cormier; Olivier Cussenot; Alain Houlgatte; Gilles Karsenty; Charlotte Maurin; François Xavier Nouhaud; Véronique Phe; Thomas Polguer; Mathieu Roumiguié; Alain Ruffion; Morgan Rouprêt Journal: World J Urol Date: 2012-12-11 Impact factor: 4.226