Lymphadenectomy in minimally invasive urologic oncology

Standardization of pelvic lymphadenectomy in the urologic community is strongly needed. The definition of limited versus extended pelvic lymphadenectomy in the literature is variable, and the indications and extent of dissection is often surgeon dependent.

Laparoscopic prostatectomy with extended lymphadenectomy can be performed safely, retrieves a higher node count, and yields positive nodes more frequently than a limited lymphadenectomy. Lymphadenectomy remains the best method to stage prostate cancer; further studies are needed, however, to assess the potential therapeutic benefits.

Laparoscopic radical cystectomy with extended lymphadenectomy provides short-term functional and oncologic outcomes that compare favorably to data published in large open series. Renal cell cancer with nodal metastases is an independent predictor of prognosis in patients with clinical M0 disease. In experienced hands, laparoscopic retroperitoneal lymphadenectomy for renal cell cancer is safe and allows for adequate staging of nodal status or tumor debulking before secondary therapy. The therapeutic benefits of lymph node dissection are still controversial.