The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma
Purpose: To explore the current role of lymph node dissection (LND) in the management of nonmetastatic localized renal cell carcinoma (RCC). Background: There is currently no proven benefit of LND in the setting of RCC, and its role remains controversial because of conflicting evidence. Patients who...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-05-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/11/3732 |
| _version_ | 1797597259359059968 |
|---|---|
| author | Megan Ngai Thenappan Chandrasekar Gennady Bratslavsky Hanan Goldberg |
| author_facet | Megan Ngai Thenappan Chandrasekar Gennady Bratslavsky Hanan Goldberg |
| author_sort | Megan Ngai |
| collection | DOAJ |
| description | Purpose: To explore the current role of lymph node dissection (LND) in the management of nonmetastatic localized renal cell carcinoma (RCC). Background: There is currently no proven benefit of LND in the setting of RCC, and its role remains controversial because of conflicting evidence. Patients who may benefit from LND are those at greatest risk of nodal disease, but the tools used to predict nodal involvement are limited due to unpredictable retroperitoneal lymphatics. The indications, templates, and extent of LND are also not standardized, adding to the ambiguity of current guidelines surrounding its use. Evidence Acquisition: A PubMed search of the literature from January 2017 to December 2022 was conducted using the search terms “renal cell carcinoma” or “renal cancer” in combination with “lymph node dissection” or “lymphadenectomy”. Case studies and editorials were excluded, whereas studies investigating the therapeutic effect of LND were classified as either demonstrating a benefit or no benefit. References of the studies and review articles were also searched for notable studies and findings that were outside the five-year literature search. The studies in this review were restricted to the English language. Results: Only a number of studies in recent years have found an association between the extent of LND and increased survival. Most studies do not indicate an associated benefit, and some even suggest a negative effect on survival. Most of these studies are retrospective. Conclusion: The therapeutic value of LND in RCC is still unclear, and although prospective data are needed, its declining rates and emerging new therapies make this unlikely. A better understanding of renal lymphatics and improved detection of nodal disease may help determine the role of LND in nonmetastatic localized RCC. |
| first_indexed | 2024-03-11T03:04:04Z |
| format | Article |
| id | doaj.art-d322a31bb3fb4cbc84526f67f3fc901d |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T03:04:04Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d322a31bb3fb4cbc84526f67f3fc901d2023-11-18T08:05:40ZengMDPI AGJournal of Clinical Medicine2077-03832023-05-011211373210.3390/jcm12113732The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell CarcinomaMegan Ngai0Thenappan Chandrasekar1Gennady Bratslavsky2Hanan Goldberg3Urology Department, SUNY Upstate Medical University, Syracuse, NY 13210, USADepartment of Urology, University of California, Orange, CA 92868, USAUrology Department, SUNY Upstate Medical University, Syracuse, NY 13210, USAUrology Department, SUNY Upstate Medical University, Syracuse, NY 13210, USAPurpose: To explore the current role of lymph node dissection (LND) in the management of nonmetastatic localized renal cell carcinoma (RCC). Background: There is currently no proven benefit of LND in the setting of RCC, and its role remains controversial because of conflicting evidence. Patients who may benefit from LND are those at greatest risk of nodal disease, but the tools used to predict nodal involvement are limited due to unpredictable retroperitoneal lymphatics. The indications, templates, and extent of LND are also not standardized, adding to the ambiguity of current guidelines surrounding its use. Evidence Acquisition: A PubMed search of the literature from January 2017 to December 2022 was conducted using the search terms “renal cell carcinoma” or “renal cancer” in combination with “lymph node dissection” or “lymphadenectomy”. Case studies and editorials were excluded, whereas studies investigating the therapeutic effect of LND were classified as either demonstrating a benefit or no benefit. References of the studies and review articles were also searched for notable studies and findings that were outside the five-year literature search. The studies in this review were restricted to the English language. Results: Only a number of studies in recent years have found an association between the extent of LND and increased survival. Most studies do not indicate an associated benefit, and some even suggest a negative effect on survival. Most of these studies are retrospective. Conclusion: The therapeutic value of LND in RCC is still unclear, and although prospective data are needed, its declining rates and emerging new therapies make this unlikely. A better understanding of renal lymphatics and improved detection of nodal disease may help determine the role of LND in nonmetastatic localized RCC.https://www.mdpi.com/2077-0383/12/11/3732renal cell carcinomakidney cancerlymph node dissection |
| spellingShingle | Megan Ngai Thenappan Chandrasekar Gennady Bratslavsky Hanan Goldberg The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma Journal of Clinical Medicine renal cell carcinoma kidney cancer lymph node dissection |
| title | The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma |
| title_full | The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma |
| title_fullStr | The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma |
| title_full_unstemmed | The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma |
| title_short | The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma |
| title_sort | current role of lymph node dissection in nonmetastatic localized renal cell carcinoma |
| topic | renal cell carcinoma kidney cancer lymph node dissection |
| url | https://www.mdpi.com/2077-0383/12/11/3732 |
| work_keys_str_mv | AT meganngai thecurrentroleoflymphnodedissectioninnonmetastaticlocalizedrenalcellcarcinoma AT thenappanchandrasekar thecurrentroleoflymphnodedissectioninnonmetastaticlocalizedrenalcellcarcinoma AT gennadybratslavsky thecurrentroleoflymphnodedissectioninnonmetastaticlocalizedrenalcellcarcinoma AT hanangoldberg thecurrentroleoflymphnodedissectioninnonmetastaticlocalizedrenalcellcarcinoma AT meganngai currentroleoflymphnodedissectioninnonmetastaticlocalizedrenalcellcarcinoma AT thenappanchandrasekar currentroleoflymphnodedissectioninnonmetastaticlocalizedrenalcellcarcinoma AT gennadybratslavsky currentroleoflymphnodedissectioninnonmetastaticlocalizedrenalcellcarcinoma AT hanangoldberg currentroleoflymphnodedissectioninnonmetastaticlocalizedrenalcellcarcinoma |