Role of lymphadenectomy in renal cell carcinoma

A hilar or limited lymph node dissection will not remove the primary lymphatic drainage area of either kidney. For a lymphadenectomy to have a therapeutic benefit, an extended dissection is required, particularly for right-sided tumors. An extended lymphadenectomy may not be justified in all patients with renal cell carcinoma, particularly those with small tumors (who rarely have lymphatic disease) or grossly positive nodes (who have a high risk of existing distant metastases). For some patients with T3 or V+ tumors and palpably normal retroperitoneal nodes, an extended nodal dissection may resect microscopically involved nodes and result in an improved survival rate. This hypothesis will not be tested appropriately until a randomized controlled study is performed.