Lymph node dissection during the surgical treatment of renal cancer in the modern era

Guilherme Godoy, Rebecca L. O'Malley, Samir S. Taneja

    Research output: Contribution to journalReview article

    Abstract

    The increasing use of routine CT scan, along with advances in imaging technology, have facilitated the early diagnosis of incidental renal masses. This has resulted in the reduction in the rate of metastatic disease diagnosis. Although surgery remains the mainstay in the treatment of renal tumors, the decreasing incidence of lymph node involvement has created controversy regarding the importance and the ideal extent of lymph node dissection, formerly considered mandatory at the time of radical nephrectomy. In this review, we critically assessed the role of lymph node dissection at the time of radical nephrectomy. To date, randomized trials have failed to show a benefit of lymph node dissection when broadly employed. This is likely due to the low prevalence of lymph node metastasis at the time of presentation, the unpredictable pattern of lymph node metastasis from renal tumors, and the continued downward stage migration of the disease. As a result, lymph node dissection for renal cancer is currently not recommended in the absence of gross lymphadenopathy. In high risk patients, lymph node dissection may be considered, but it remains controversial and -more clinical evidence is warranted. Extended lymph node dissection is still recommended in individuals with isolated gross nodal disease or those with lymphadetiopathy at the time of cytoreductive surgery prior to systemic therapy. A practical approach is summarized in an algorithm form.

    Original languageEnglish (US)
    Pages (from-to)132-142
    Number of pages11
    JournalInternational Braz J Urol
    Volume34
    Issue number2
    DOIs
    StatePublished - 2008

    Keywords

    • Disease management
    • Kidney neoplasms
    • Lymph node excision
    • Lymph nodes
    • Nephrectomy
    • Review

    ASJC Scopus subject areas

    • Urology

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