Is Lymphadenectomy Necessary in the Surgical Treatment of Upper Urinary Tract Urothelial Carcinoma?

The role of lymph node dissection (LND) in the treatment of upper urinary tract transitional cell carcinoma (TCC) is still controversial. In this review, we aimed to put forth the present clinical approach regarding this issue in the light current literature. Nowadays, the assessment of lymph node involvement cannot be done accurately by current imaging modalities. LND is a gold standard in detecting lymph node involvement. Although lymph node involvement provides information about survival, the contribution of LND to survival is also controversial. Despite some studies reporting no contribution of LND to survival among T1 patients, many retrospective studies have shown an increase in survival among muscle-invasive, locally invasive and lymph node-positive patients when LND was performed completely, removing all regional lymph nodes. Laparoscopic nephroureterectomy has similar oncological and complication results as open surgery and can be used equivalently in T1T2/ N0 tumors. However, laparoscopic nephroureterctomy until proven otherwise is contraindicated in the treatment of invasive or large (T3-T4 and/or N+/M+) tumours.