Abstract
Regional lymphadenectomy, with both its diagnostic and therapeutic roles, serves as an integral component of the management of many malignancies. Extended pelvic lymph node dissection (LND) is the standard of care for urothelial carcinoma of the bladder, with the extent of lymphadenectomy correlating positively with cancer-related outcomes. Given their histologic similarities with bladder cancer, it is reasonable to hypothesize that a similar relationship exists for upper tract urothelial carcinomas (UTUCs). However, the data published to date have failed to consistently demonstrate a therapeutic benefit of regional LND for UTUC. As a consequence, utilization of regional lymphadenectomy remains at the discretion of the surgeon, the extent of LND lacks standardization, and its clinical utility continues to be debated. In order to better clarify the existing data, we present a review of the role of regional lymphadenectomy in patients with UTUC.
Key Points
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Patients with pathologic node-positive (pN+) upper tract urothelial carcinoma (UTUC) have a poor overall survival rate
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The role of regional lymphadenectomy for UTUC is currently undefined, with conflicting data in the literature
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The template for regional lymphadenectomy has not been standardized, which has in part contributed to lymph node dissections being performed in only 44–67% of patients undergoing surgery for UTUC
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The therapeutic benefit of adjuvant chemotherapy for patients with pN+ UTUC remains unproven
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All authors researched data and discussed the content of the manuscript. J. Messer and J. D. Raman wrote the article and performed review and editing of the manuscript before submission.
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Messer, J., Lin, Y. & Raman, J. The role of lymphadenectomy for upper tract urothelial carcinoma. Nat Rev Urol 8, 394–401 (2011). https://doi.org/10.1038/nrurol.2011.78
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DOI: https://doi.org/10.1038/nrurol.2011.78
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