Role of lymphadenectomy for patients undergoing radical nephrectomy for renal cell carcinoma

The potential benefits of a lymph node dissection (LND) include more accurate staging, decreased local recurrence rates, and improved survival. However, only limited data support the potential benefits of routine, extensive LND for renal cell carcinoma (RCC). Because of lack of data, no clear practice standard has been established about whether to perform LND and, if so, to what extent. The value of LND for RCC is only relevant if the pattern of lymphatic spread is predictable, which it is not. However, although little evidence supports the value of LND for RCC, it is probable that an occasional patient will have very early metastasis confined to the area of the primary and secondary major lymphatic flow medially and perhaps will benefit therapeutically. In this case, a limited LND is supportable. No information currently available strongly supports the value of a more extensive and potentially more morbid LND for either staging or therapeutic value. Extensive investigation is necessary in order to establish LND as a standard component of RCC surgery.