The role of lymphadenectomy for upper tract urothelial carcinoma

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.

Laparoendoscopic single‐site (LESS) robot‐assisted nephroureterectomy: comparison with conventional multiport technique in the management of upper urinary tract urothelial carcinoma

“…Indeed, a recent review concluded that there seemed to be no consistent benefit in outcomes when comparing patients who either did or did not undergo regional lymphadenectomy although regional lymphadenectomy allowed the accurate staging of UUT‐UC. The benefits of adjuvant systemic therapies for UUT‐UC remain unproven . Nevertheless, the lack of nodal status in the present study remained a major limitation.…”

“…The rationale for PLND in UUT‐UC is mainly extrapolated from evidence of the therapeutic benefits of PLND for bladder cancer , but the true role of RPLND in UUT‐UC is controversial. While some authors have recommended RPLND in higher stage tumours , others have failed to show any survival benefits associated with RPLND .…”

Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy

“…Furthermore, we observed that LND might have a minimal positive impact on OS or CSS in pT1/2 patients. This may result from the difficulty to standardize indication or template for LND [4, 19]. In consequence, it simply cannot be argued that LND is of no benefit for organ-confined UTUC patients.…”

Perioperative chemotherapy for upper tract urothelial cancer

“…Laparoscopic surgery generally delivers outcomes for low-grade and low-stage UTUC that are equivalent to conventional open surgery, although longer term follow-up is awaited for patients with locally advanced disease. 21-25 Although the roles of lymphadenectomy and kidney-sparing endoscopic approaches have not been definitively established, 26 the potential importance of regional lymph node dissection (especially in patients with high-grade disease) can be extrapolated from study findings relating to UCC of the bladder. 27 Outcomes following surgery for locally advanced UTUC are suboptimal ( Figure 1) and have not improved over the past 20 years.…”