Potential benefit of lymph node dissection during radical nephrectomy for kidney cancer: A review and critical analysis of current literature

Marchioni, Michele; Magli, Igino Andrea; Bertolo, Riccardo; Carbonara, Umberto; Erdem, Selçuk; Ingels, Alexandre; Muselaers, Stijn; Kara, Önder; Mascitti, Marco; Klatte, Tobias; Kriegmair, Maximilian C.; Pavan, Nicola; Roussel, Eduard; Pecoraro, Angela; Marandino, Laura; Campi, Riccardo; Schips, Luigi

doi:10.1016/j.ajur.2022.03.007

Cited by 4 publications

(4 citation statements)

References 80 publications

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“…On the other hand, during cytoreductive nephrectomy (CN) for metastatic RCC, LND has not shown improvement in patient survival [2]. One propensity score matched study analyzed 305 metastatic RCC patients who underwent CN, including188 patients who underwent LND.…”

Section: Oncological Efficacy Of Lymph Node Dissectionmentioning

confidence: 99%

“…The extent and template of LND have not been clearly standardized [2,3]. According to a prospective study evaluating the lymphatic drainage pattern of renal tumor in vivo, lymphatic drainage exhibited individual variation [14].…”

Section: Extent and Template Of Lymph Node Dissectionmentioning

confidence: 99%

“…Renal cell carcinoma (RCC) is one of the most common urological cancers worldwide, and lymph node (LN) metastasis has a poor prognosis [1][2][3]. LN dissection (LND) is not only the best approach to diagnose LN metastasis (i.e., staging), but also an effective therapeutic option for many solid malignancies including other urologic cancers [2]. For RCC, the role of LND remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Role of lymphadenectomy during primary surgery for kidney cancer

Bekku

Kawada

Yanagisawa

et al. 2023

Current Opinion in Urology

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Purpose of reviewLymph node dissection (LND) during radical nephrectomy (RN) for renal cell carcinoma (RCC) is not considered as a standard. The emergence of robot-assisted surgery and effective immune checkpoint inhibitors (ICI) in recent years may change this and lymph node (LN) staging has become easier and has a clinical impact. In this review, we aimed to reconsider the role of LND today. Recent findingsAlthough the extent of LND has still not been well established, removal of more LN seems to provide better oncologic outcomes for a select group of patients with high-risk factors such as clinical T3-4. Adjuvant therapy using pembrolizumab has been shown to improve disease free survival if complete resection of metastatic lesions as well as the primary site is obtained in combination. Robot assisted RN for localized RCC has been widespread and the studies regarding LND for RCC has been recently appeared.

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Section: Oncological Efficacy Of Lymph Node Dissectionmentioning

confidence: 99%

Section: Extent and Template Of Lymph Node Dissectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of lymphadenectomy during primary surgery for kidney cancer

Bekku

Kawada

Yanagisawa

et al. 2023

Current Opinion in Urology

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“…Currently, the role of lymph node dissection (LND) in cytoreductive nephrotomy (CN) is controversial and not generally endorsed. 1 However, historic studies demonstrated that information about lymph node invasion (LNI) status represents an independent predictor of cancer-specific mortality (CSM). 2 , 3 Specifically, patients with LNI historically exhibited markedly worse survival than those without LNI (pN1 vs pN0).…”

mentioning

confidence: 99%

Prognostic Significance of Pathologic Lymph Node Invasion in Metastatic Renal Cell Carcinoma in the Immunotherapy Era

Scheipner,

Barletta,

Cano Garcia

et al. 2023

Ann Surg Oncol

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Background This study aimed to test the prognostic significance of pathologically confirmed lymph node invasion in metastatic renal cell carcinoma (mRCC) patients in this immunotherapy era. Methods Surgically treated mRCC patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2018. Kaplan-Meier plots and multivariable Cox-regression models were fitted to test for differences in cancer-specific mortality (CSM) and overall mortality (OM) according to N stage (pN0 vs pN1 vs. pNx). Subgroup analyses addressing pN1 patients tested for CSM and OM differences according to postoperative systemic therapy status. Results Overall, 3149 surgically treated mRCC patients were identified. Of these patients, 443 (14%) were labeled as pN1, 812 (26%) as pN0, and 1894 (60%) as pNx. In Kaplan-Meier analyses, the median CSM-free survival was 15 months for pN1 versus 40 months for pN0 versus 35 months for pNx (P < 0.001). In multivariable Cox regression analyses, pN1 independently predicted higher CSM (hazard ratio [HR], 1.88; P < 0.01) and OM (HR, 1.95; P < 0.01) relative to pN0. In sensitivity analyses addressing pN1 patients, postoperative systemic therapy use independently predicted lower CSM (HR, 0.73; P < 0.01) and OM (HR, 0.71; P < 0.01). Conclusion Pathologically confirmed lymph node invasion independently predicted higher CSM and OM for surgically treated mRCC patients. For pN1 mRCC patients, use of postoperative systemic therapy was associated with lower CSM and OM. Consequently, N stage should be considered for individual patient counseling and clinical decision-making. Graphical abstract Consort diagram of the study population.

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