Lymph Node Dissection in Upper Tract Urothelial Carcinoma: Current Status and Future Perspectives

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• Conventional imaging limits lymph node metastasis (LNM) detection in upper tract urothelial carcinoma (UTUC).
• 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18FDG-PET/CT) has low specificity for preoperative LNM detection.

Purpose of the Study:

• To evaluate the role of lymph node dissection (LND) in upper tract urothelial carcinoma (UTUC).
• To assess LND's implications for staging, management outcomes, and future perspectives in UTUC.

Main Methods:

• Narrative review of existing literature on lymph node dissection in UTUC.
• Analysis of current and emerging imaging techniques for lymph node metastasis detection.
• Evaluation of surgical approaches and preoperative factors influencing nodal staging.

Main Results:

• Lymph node dissection (LND) is the primary nodal staging tool for UTUC, but its therapeutic benefit is uncertain.
• Preoperative factors and advanced imaging (e.g., PET/CT) show potential for improved LNM detection and staging.
• Minimally invasive surgical techniques allow for LND with reduced morbidity.

Conclusions:

• Further multi-center studies are essential to fully understand the advantages and limitations of LND in UTUC.
• Advances in imaging and risk assessment may enhance LND's role in UTUC management.
• Long-term outcomes of alternative staging and treatment strategies for UTUC require comprehensive evaluation.