2025 Volume 38 Issue 1 Pages 99-104
Lymph node dissection is often deemed not to provide sufficient benefits compared to the complexity of the procedure and the risk of complications, leading to differences in practice between medical institutions. In urological cancers requiring retroperitoneal lymph node dissection, testicular cancer, renal pelvis/ureteral cancer, and renal cancer are notable examples. Although the extent of the dissection is not significantly different among these cancers, the purpose of lymph node dissection varies.
For testicular cancer, lymph node dissection aims to completely remove residual cancer cells following chemotherapy for advanced cancer. While there are slight differences in the indication between seminoma and non-seminoma, in seminoma, if the residual tumor is small, the detection rate of cancer is low, allowing for the possibility of observation while considering imaging findings. In renal pelvis and ureteral cancer, while there are many reports supporting the diagnostic value of lymph node dissection, its therapeutic significance has not been fully investigated. Recently, risk stratification has been recommended, suggesting lymph node dissection be performed with nephroureterectomy in high-risk patients. However, there is no clear evidence of improved prognosis, and more data are needed. The significance of lymph node dissection in renal cancer depends on the preoperative assessment. If there is no preoperative lymph node enlargement, the likelihood of lymph node metastasis is low, and dissection is not considered to contribute to recurrence prevention or improved survival. On the other hand, if lymph node metastasis is suspected preoperatively, many believe that lymph node dissection has diagnostic value, as it enables pathological diagnosis, which may guide the selection of adjuvant chemotherapy after surgery.
Retroperitoneal lymph node dissection is neither standardized in terms of indications nor surgical techniques, raising questions about the reproducibility of previous reports. Additionally, the risk of complications, including lymphatic fistula, remains a concern. In the future, it is hoped that the widespread adoption of robot-assisted surgery will address these issues.
