The role of lymphadenectomy in upper tract urothelial carcinoma

Abstract

  Lymph node dissection (LND) for upper urothelial carcinoma is recommended in advanced cases of upper tract urothelial carcinoma (UTUC), although the recommendation is weak in each guideline. The reason for the weak recommendation is the lack of randomized trials, but the fact is that standardization of LND techniques is difficult. Another reason is that the results from previous retrospective studies have not been consistent in their therapeutic role. However, we have reported reasonable anatomical template of reginal lymph nodes in UTUC. Template-based LND appears to improve oncological outcome in many previous studies.

  Robotic-assisted total nephroureterectomy (RANU) will be covered by insurance in Japan from 2022. The number of cases of RANU has been increasing both globally and domestically. The issue is the feasibility of LND in robotic surgery. Although the data has not accumulated enough, we believe that LND during RANU can be done as effective as that in open surgery. Laparoscopic radical nephroureterectomy has also been reported to provide poorer cancer control than open surgery in patients with pT3 or more advanced cancer according to the randomized trial. By ensuring lymph node dissection, RANU is expected to show similar results to open surgery, even in patients with pT3 or higher.