LYMPH NODE DISSECTION FOR RENAL CELL CARCINOMA

Abstract

  High-level evidence is limited regarding the indication, extent, and therapeutic significance of lymph node dissection for renal cell carcinoma. In practice, extensive lymph node dissection is rarely performed except in advanced cases. Lymph node metastasis is associated with poor prognosis, and accurate staging through lymph node dissection can aid in predicting prognosis and decision-making for postoperative adjuvant therapy. Preoperative lymph node enlargement often results in false positives, and cases without enlargement exhibit a low frequency of pathologically positive lymph nodes, even if lymph node dissection is performed. Therefore, routine lymph node dissection is not recommended in all cases ; however, it has diagnostic value in cases with a high risk of pathologically positive lymph nodes. In contrast, little evidence supports its therapeutic significance, and prospective studies have not demonstrated its therapeutic benefits. Retrospective studies have demonstrated improvements in the prognosis of high-risk patients. There is no consensus on the extent of lymph node dissection or the necessity for extended dissection, making the appropriate extent of dissection difficult to determine. Considering the complications associated with extensive lymph node dissection, the decision whether to perform lymph node dissection and its extent must be made carefully.