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The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma

Purpose: To explore the current role of lymph node dissection (LND) in the management of nonmetastatic localized renal cell carcinoma (RCC). Background: There is currently no proven benefit of LND in the setting of RCC, and its role remains controversial because of conflicting evidence. Patients who...

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Autores principales: Ngai, Megan, Chandrasekar, Thenappan, Bratslavsky, Gennady, Goldberg, Hanan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10253302/
https://www.ncbi.nlm.nih.gov/pubmed/37297925
http://dx.doi.org/10.3390/jcm12113732
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author Ngai, Megan
Chandrasekar, Thenappan
Bratslavsky, Gennady
Goldberg, Hanan
author_facet Ngai, Megan
Chandrasekar, Thenappan
Bratslavsky, Gennady
Goldberg, Hanan
author_sort Ngai, Megan
collection PubMed
description Purpose: To explore the current role of lymph node dissection (LND) in the management of nonmetastatic localized renal cell carcinoma (RCC). Background: 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. Evidence Acquisition: 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. Results: 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. Conclusion: 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.
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spelling pubmed-102533022023-06-10 The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma Ngai, Megan Chandrasekar, Thenappan Bratslavsky, Gennady Goldberg, Hanan J Clin Med Review Purpose: To explore the current role of lymph node dissection (LND) in the management of nonmetastatic localized renal cell carcinoma (RCC). Background: 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. Evidence Acquisition: 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. Results: 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. Conclusion: 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. MDPI 2023-05-29 /pmc/articles/PMC10253302/ /pubmed/37297925 http://dx.doi.org/10.3390/jcm12113732 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ngai, Megan
Chandrasekar, Thenappan
Bratslavsky, Gennady
Goldberg, Hanan
The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma
title The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma
title_full The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma
title_fullStr The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma
title_full_unstemmed The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma
title_short The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma
title_sort current role of lymph node dissection in nonmetastatic localized renal cell carcinoma
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10253302/
https://www.ncbi.nlm.nih.gov/pubmed/37297925
http://dx.doi.org/10.3390/jcm12113732
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