Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer

The oncological efficacy of routine lymphadenectomy (lymph node dissection [LND]) at the time of radical nephroureterectomy (RNU) remains controversial.

To systematically review the available literature assessing the impact of LND in upper tract urothelial carcinoma (UTUC) patients.

Embase, Medline, and Cochrane databases were searched for all studies comparing outcomes of patients undergoing RNU without LND versus any form of LND. We identified nine retrospective studies eligible for inclusion in this systematic review. We took cancer-specific survival (CSS) as the primary end point, and performed a narrative review and risk of bias assessment.

Six studies compared outcomes of no LND versus LND. Three studies compared complete LND versus incomplete LND versus no LND. The incidence of pN+ in patients with high-stage (≥pT2) tumours ranged from 14.3% to 40%. Pre- and postoperative characteristics differed among the study groups, potentially biasing the results, as demonstrated by the risk of bias assessment, potentially favouring the LND group. Oncological outcomes such as cancer-specific, overall, recurrence-free, and metastasis-free survival were reviewed, demonstrating a survival benefit with LND in high-stage disease of the renal pelvis.

Template-based and complete LND improves CSS in patients with high-stage (≥pT2) UTUC and reduces the risk of local recurrence. The impact of LND in ureteral tumours remains uncertain.

Studies comparing radical nephroureterectomy with or without the removal of nodes (lymph node dissection [LND]) were analysed. LND improves survival in patients with high-stage disease of the renal pelvis, if it is performed according to an anatomical template-based approach.

European urology focus. 2017 Nov 17 [Epub ahead of print]

Jose Luis Dominguez-Escrig, Benoit Peyronnet, Thomas Seisen, Harman M Bruins, Cathy Yuhong Yuan, Marko Babjuk, Andreas Böhle, Maximilian Burger, Eva M Compérat, Paolo Gontero, Thomas Lam, Steven MacLennan, Hugh Mostafid, Joan Palou, Bas W G van Rhijn, Richard J Sylvester, Richard Zigeuner, Shahrokh F Shariat, Morgan Rouprêt

Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain. Electronic address: ., Department of Urology, University of Rennes, Rennes, France., Academic Department of Urology, La Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France., Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands., Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada., Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic., Department of Urology, HELIOS Agnes-Karll-Krankenhaus, Bad Schwartau, Germany., Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany., Department of Pathology, La Pitié-Salpétrière Hospital, UPMC, Paris, France., A.O.U. San Giovanni Battista-le Molinette, Department of Urology, University of Turin, Turin, Italy., Academic Urology Unit, University of Aberdeen, Scotland, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK., Academic Urology Unit, University of Aberdeen, Scotland, UK., Department of Urology, North Hampshire Hospital, Basingstoke, UK., Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain., Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antonie van Leeuwenhoek Hospital, Amsterdam, The Netherlands., European Association of Urology Guidelines Office, Brussels, Belgium., Department of Urology, Medical University of Graz, Graz, Austria., Medical University of Vienna, Vienna General Hospital, Vienna, Austria.