Articles

Collaborative Review – Urothelial Cancer

Lymphadenectomy at the Time of Nephroureterectomy for Upper Tract Urothelial Cancer

By: Marco Roscignoa lowast , Maurizio Brausib, Axel Heidenreichc, Yair Lotand, Vitaly Margulisd, Shahrokh F. Shariate, Hendrik Van Poppelf and Richard Zigeunerg

European Urology, Volume 60 Issue 1, October 2011, Pages 776-783

Published online: 01 October 2011

Keywords: Upper tract urothelial neoplasms, Lymphadenectomy, Lymphatic metastases, Nephroureterectomy, Survival

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Abstract

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.

Take Home Message

An extended lymph node dissection (LND) can provide better disease staging and may be curative in patients with limited nodal disease. However, current evidence is based on retrospective studies, and this limits the ability to standardize either the indication or the extent of LND.

Keywords: Upper tract urothelial neoplasms, Lymphadenectomy, Lymphatic metastases, Nephroureterectomy, Survival.

Footnotes

a Department of Urology, Ospedali Riuniti di Bergamo, Bergamo, Italy

b Department of Urology, Ausl Modena, Italy Ospedale Sant’Agostino – Estense, Modena, Italy

c Department of Urology, RWTH University Aachen, Aachen, Germany

d Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA

e Department of Urology, Weill Medical College of Cornell University, New York, NY, USA

f Department of Urology, University Hospital of Leuven, Leuven, Belgium

g Department of Urology, Medical University of Graz, Graz, Austria

lowast Corresponding author. Tel. +39035269292.

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