Department of Urology, Comprehensive Cancer Center, Medical University of Vienna.
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Curr Opin Urol. 2023 Jul 1;33(4):294-301. doi: 10.1097/MOU.0000000000001095. Epub 2023 Apr 10.
Lymph node dissection (LND) during radical nephrectomy (RN) for renal cell carcinoma (RCC) is not considered as a standard. The emergence of robot-assisted surgery and effective immune checkpoint inhibitors (ICI) in recent years may change this and lymph node (LN) staging has become easier and has a clinical impact. In this review, we aimed to reconsider the role of LND today.
Although the extent of LND has still not been well established, removal of more LN seems to provide better oncologic outcomes for a select group of patients with high-risk factors such as clinical T3-4. Adjuvant therapy using pembrolizumab has been shown to improve disease free survival if complete resection of metastatic lesions as well as the primary site is obtained in combination. Robot assisted RN for localized RCC has been widespread and the studies regarding LND for RCC has been recently appeared.
The staging and surgical benefits and its extent of LND during RN for RCC remains unclear, but it is becoming increasingly important. Technologies that allow an easier LND and adjuvant ICI that improve survival in LN-positive patients are engaging the role of LND, a procedure that was needed, but almost never done, is now indicated sometimes. Now, the goal is to identify the clinical and molecular imaging tools that can help identify with sufficient accuracy who needs a LND and which LNs to remove in a targeted personalized approach.
根治性肾切除术（RN）中进行淋巴结清扫（LND）并不被认为是标准治疗。近年来，机器人辅助手术和有效的免疫检查点抑制剂（ICI）的出现可能改变这一现状，并且淋巴结（LN）分期变得更加容易，并具有临床影响。在这篇综述中，我们旨在重新考虑当今 LND 的作用。
尽管 LND 的范围仍未得到充分确定，但对于具有高风险因素（如临床 T3-4）的特定患者群体，切除更多的 LN 似乎可以提供更好的肿瘤学结果。如果在联合治疗中完全切除转移病灶和原发部位，使用 pembrolizumab 进行辅助治疗已被证明可以改善无病生存率。机器人辅助 RN 治疗局限性 RCC 已经广泛开展，最近也出现了关于 RCC 中 LND 的研究。
在 RN 治疗 RCC 中，LND 的分期、手术获益及其范围仍不明确，但它变得越来越重要。允许更容易进行 LND 的技术和改善 LN 阳性患者生存的辅助 ICI 正在发挥 LND 的作用，这种曾经需要但几乎从未进行过的手术现在有时是必要的。现在的目标是确定临床和分子影像学工具，以便能够足够准确地识别出哪些患者需要进行 LND 以及需要靶向性地切除哪些 LN。
