Re: The Role of Lymph Node Dissection in the Management of Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

The appropriate role of lymph node dissection (LND) in the management of patients with renal cell carcinoma (RCC) is still a matter of debate. There is ample evidence that LND is the most accurate modality for staging the regional lymph nodes (LNs), which may harbor metastatic disease in greater than one-third of patients with high-risk RCC. The presence of LN metastases is an independent negative prognostic factor in this disease and accurate determination of LN status not only helps with patient counselling regarding prognosis and tailoring of postoperative surveillance schedules, but it also identifies patients at high risk of systemic disease recurrence who may qualify for clinical trials of adjuvant systemic therapies. Meanwhile, the therapeutic value of LND has been brought into question by a randomized trial (European Organisation for Research and Treatment of Cancer; EORTC 30881) that showed no difference in progression-free or overall survival between patients who were treated with radical nephrectomy (RN) and LND and those treated with RN alone. Given that most patients enrolled in this trial had small renal masses and therefore were at low risk for LN metastases, the question of whether patients with high-risk tumors derive a therapeutic benefit from a standardized, extended LND remains unanswered.

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Systematic Review of Adrenalectomy and Lymph Node Dissection in Locally Advanced Renal Cell Carcinoma

European Urology ◽

10.1016/j.eururo.2013.04.033 ◽

2013 ◽

Vol 64 (5) ◽

pp. 799-810 ◽

Cited By ~ 48

Author(s):

Hendrika J. Bekema ◽

Steven MacLennan ◽

Mari Imamura ◽

Thomas B.L. Lam ◽

Fiona Stewart ◽

...

Keyword(s):

Systematic Review ◽

Renal Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Lymph Node Dissection ◽

Renal Cell ◽

Locally Advanced ◽

Advanced Renal Cell Carcinoma ◽

Node Dissection

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The Current Role of Lymph Node Dissection in the Management of Renal Cell Carcinoma

International Journal of Surgical Oncology ◽

10.1155/2011/816926 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Joseph Edmund Jamal ◽

Thomas William Jarrett

Keyword(s):

Renal Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Lymph Node Dissection ◽

Metastatic Disease ◽

Renal Cell ◽

Node Dissection ◽

Regional Lymph Nodes ◽

Renal Masses

The role of lymph node dissection remains controversial in the surgical management of renal cell carcinoma. Incidental renal masses are being diagnosed at increasing rates due to the routine use of CT scans. Despite the increase in incidental diagnosis of renal masses, 20% to 30% of patients present with metastatic disease. Currently, surgeons do not routinely perform lymph node dissection unless there is gross evidence of lymphadenopathy, as patients without clinical evidence of lymphadenopathy rarely have positive nodes at the time of surgery. Patients with metastatic disease to the regional lymph nodes have a poor overall prognosis. However, some evidence supports a therapeutic benefit of lymphadenectomy in these patients. Further, the staging information gained from diagnosing lymph node involvement may allow for the use of new agents to treat metastatic disease and effect outcomes.

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