Ngai Megan, Chandrasekar Thenappan, Bratslavsky Gennady, Goldberg Hanan
Urology Department, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Department of Urology, University of California, Orange, CA 92868, USA.
J Clin Med. 2023 May 29;12(11):3732. doi: 10.3390/jcm12113732.
To explore the current role of lymph node dissection (LND) in the management of nonmetastatic localized renal cell carcinoma (RCC).
There is currently no proven benefit of LND in the setting of RCC, and its role remains controversial because of conflicting evidence. Patients who may benefit from LND are those at greatest risk of nodal disease, but the tools used to predict nodal involvement are limited due to unpredictable retroperitoneal lymphatics. The indications, templates, and extent of LND are also not standardized, adding to the ambiguity of current guidelines surrounding its use.
A PubMed search of the literature from January 2017 to December 2022 was conducted using the search terms "renal cell carcinoma" or "renal cancer" in combination with "lymph node dissection" or "lymphadenectomy". Case studies and editorials were excluded, whereas studies investigating the therapeutic effect of LND were classified as either demonstrating a benefit or no benefit. References of the studies and review articles were also searched for notable studies and findings that were outside the five-year literature search. The studies in this review were restricted to the English language.
Only a number of studies in recent years have found an association between the extent of LND and increased survival. Most studies do not indicate an associated benefit, and some even suggest a negative effect on survival. Most of these studies are retrospective.
The therapeutic value of LND in RCC is still unclear, and although prospective data are needed, its declining rates and emerging new therapies make this unlikely. A better understanding of renal lymphatics and improved detection of nodal disease may help determine the role of LND in nonmetastatic localized RCC.
探讨淋巴结清扫术（LND）在非转移性局限性肾细胞癌（RCC）治疗中的当前作用。
目前，LND在RCC治疗中尚未被证实具有益处，由于证据相互矛盾，其作用仍存在争议。可能从LND中获益的患者是那些发生淋巴结疾病风险最高的患者，但由于腹膜后淋巴管不可预测，用于预测淋巴结受累的工具有限。LND的适应证、模板和范围也未标准化，这增加了当前围绕其使用的指南的模糊性。
使用搜索词“肾细胞癌”或“肾癌”与“淋巴结清扫术”或“淋巴结切除术”相结合，对2017年1月至2022年12月的文献进行了PubMed搜索。排除了病例研究和社论，而将研究LND治疗效果的研究分类为显示有益或无益。还搜索了研究和综述文章的参考文献，以查找五年文献搜索之外的著名研究和发现。本综述中的研究仅限于英文。
近年来只有一些研究发现LND范围与生存率提高之间存在关联。大多数研究未表明存在相关益处，有些甚至表明对生存率有负面影响。这些研究大多是回顾性的。
LND在RCC中的治疗价值仍不明确，虽然需要前瞻性数据，但其使用率下降和新疗法不断涌现使得这种可能性不大。更好地了解肾淋巴管和改进淋巴结疾病的检测可能有助于确定LND在非转移性局限性RCC中的作用。
