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Lymph node dissection for upper tract urothelial carcinoma: A systematic review.

Vinson Wai-Shun Chan1, Chris Ho Ming Wong2, Yuhong Yuan3

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Arab Journal of Urology
|March 25, 2021
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Summary

Lymph node dissection (LND) during nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) shows no overall survival benefit. However, LND may improve recurrence-free survival in advanced UTUC cases without increasing complications.

Keywords:
UTUCUrothelial carcinomalymph node dissectionnephroureterectomy

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Area of Science:

  • Urology
  • Oncology
  • Systematic Review & Meta-Analysis

Background:

  • Upper tract urothelial carcinoma (UTUC) is a rare malignancy.
  • The role of lymph node dissection (LND) during nephroureterectomy (NU) for UTUC remains debated.
  • Evidence regarding survival outcomes and complication rates associated with LND in UTUC is limited.

Purpose of the Study:

  • To systematically review the literature on lymph node dissection (LND) in nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC).
  • To evaluate the impact of LND on survival outcomes (recurrence-free survival [RFS], cancer-specific survival [CSS], overall survival [OS]).
  • To assess the association between LND and postoperative complications.

Main Methods:

  • A systematic literature search was conducted using relevant keywords and Medical Subject Headings (MeSH) terms across multiple databases.
  • Meta-analyses were performed for outcomes reported with consistent definitions in at least two studies.
  • Outcomes not suitable for meta-analysis were reviewed narratively, adhering to the PRISMA statement.

Main Results:

  • The review included 21 studies for qualitative analysis and 11 for quantitative meta-analysis.
  • No significant improvement in RFS, CSS, or OS was detected with LND overall.
  • However, LND significantly worsened RFS in patients with pT2/pT3 UTUC when not performed, and removing >8 lymph nodes may benefit pN0 patients. LND was not linked to increased postoperative complications.

Conclusions:

  • Lymph node dissection (LND) does not confer additional benefits in recurrence-free survival (RFS), cancer-specific survival (CSS), or overall survival (OS) for upper tract urothelial carcinoma (UTUC) generally.
  • A potential RFS benefit from LND exists for patients with muscle-invasive and advanced UTUC.
  • Performing LND during nephroureterectomy (NU) for UTUC is not associated with an increased risk of postoperative complications.