Lymphadenectomy for renal cell carcinoma and urothelial carcinoma of the upper urinary tract: analysis of evidence in the minimally invasive era.

Although lymphnode dissection (LND) provides staging and therapeutic benefit in bladder cancer, the role of lymphadenectomy in renal cell carcinoma (RCC) and urothelial cancer of the upper urinary tract (UCUUT) remains undefined. The aim of this paper was to examine the staging and therapeutic role of LND in RCC and UCUUT with emphasis on applicability to modern minimally invasive approaches. A Pubmed search was conducted to identify literature published between January 1, 2008 and March 11, 2013 addressing the role of lymphadenectomy in renal and upper urinary tract cancer. Key words included "lymphadenectomy", lymphnode dissection", "lymphnode excision", "lymphatic metastasis", "renal cancer", "renal neoplasm", "renal cell carcinoma", "kidney cancer", "kidney neoplasm", "upper urinary tract", "urothelial carcinoma", "kidney pelvis", "ureteral neoplasm", "transitional cell", "ureter, and upper tract urothelial neoplasm". The staging benefit of LND in RCC and UCUUT remains controversial although lymphnode metastasis is an important prognostic factor in both disease processes. It is not well established whether LND improves survival in RCC and UCUUT. There is no consensus regarding the optimal lymphnode yield or template. Much of the current literature is derived from studies of open surgery. Patients with higher grade and stage may derive the most benefit from LND. LND may provide both staging and survival benefit in select patients undergoing surgery for treatment of either RCC or UTUUC. Patients with clinical stage T2 or higher, those with aggressive histologic subtypes and features, and those with clinically enlarged nodes should undergo LND. Simple LND templates based on tumor location should be used and are amenable to both open and minimally invasive approaches.