The role of extensive lymphadenectomy in upper tract malignant disease

Upper tract malignancies represent an estimated 5 %-10 % of urothelial cancers, with roughly 3,000 new cases per year in the United States. These tumors often present at an advanced stage, with invasion and lymph node metastases. There are no large randomized prospective studies demonstrating the benefit of lymph node dissection in upper tract urothelial cancer, and as such, definitive guidelines on the surgical template and timing are lacking. Laparoscopic and robotic-assisted surgical techniques are well-established for nephroureterectomy, but are also emerging for retroperitoneal lymph node dissection. The treatment of these tumors still needs to be tailored based on patient and tumor characteristics. The purpose of our review is to update findings on the utility, techniques, and outcomes of lymphadenectomy for upper tract urothelial cancer.