Lymph node dissection in radical nephrectomy for renal cell carcinoma: is it necessary?

Lymph node dissection is an essential step in radical nephrectomy for renal cell carcinoma, but lymph node metastases are present in no more than 15% of category M0 renal cell cancers and the cure rate of patients with lymph node involvement is usually poor. Therefore it can be assumed that less than 5% of patients benefit from lymphadenectomy. Lymph node dissection of limited extent is useful in enabling easier control of the great vessels, and radical dissection may be confined to patients of high T categories in whom the chance for nodal involvement is higher.