Peyrottes Arthur, Califano Gianluigi, Ouzaïd Idir, Lainé-Caroff Paul, Long Depaquit Thibaut, Hermieu Jean-François, Xylinas Evanguelos
Department of Urology, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France.
Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy.
Front Surg. 2022 Mar 24;9:852969. doi: 10.3389/fsurg.2022.852969. eCollection 2022.
Although lymphonodal dissection is well-accepted for muscle-invasive bladder cancer management, its role is still debated during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). The aim of this study was to summarize the current knowledge concerning the indication, anatomical template, prognostic, and therapeutic roles of lymph node dissection (LND) performed at the time of RNU. Quality control markers, such as the number of lymph nodes (LN) removed, lymph node density, and safety of the different surgical approaches, were assessed. We performed a narrative review using the PubMed and ClinicalTrials.gov databases. We identified and analyzed articles based on the practice and the role of lymph node dissection for non-metastatic UTUC. There are no clear guidelines regarding the indication of LND for UTUC, but aggressive tumors may beneficiate from lymphadenectomy since lymph node invasion is a clear independent poor prognostic factor, allowing for adjuvant treatments. It seems that an extended lymphadenectomy may provide therapeutic advantages as a higher number of nodes removed may be related to the removal of undetected LNs micrometastases and a subsequent improvement in recurrence rate and cancer-specific survival. Clear anatomical templates are thus needed based on the location and the laterality of the primary tumor.
尽管淋巴结清扫在肌层浸润性膀胱癌的治疗中已被广泛接受，但其在根治性肾输尿管切除术（RNU）治疗上尿路尿路上皮癌（UTUC）中的作用仍存在争议。本研究的目的是总结目前关于RNU时进行淋巴结清扫（LND）的适应证、解剖模板、预后及治疗作用的相关知识。评估了质量控制指标，如切除的淋巴结数量、淋巴结密度以及不同手术方式的安全性。我们使用PubMed和ClinicalTrials.gov数据库进行了叙述性综述。我们根据淋巴结清扫在非转移性UTUC中的实践和作用来识别和分析文章。关于UTUC的LND适应证尚无明确指南，但侵袭性肿瘤可能从淋巴结切除中获益，因为淋巴结侵犯是明确的独立不良预后因素，可据此进行辅助治疗。似乎扩大淋巴结清扫可能具有治疗优势，因为切除更多的淋巴结可能与清除未检测到的微转移淋巴结以及随后复发率和癌症特异性生存率的改善有关。因此，需要根据原发肿瘤的位置和侧别制定明确的解剖模板。
