Lymph Node Dissection for Upper Tract Urothelial Carcinoma: A Critical Appraisal of Lymph Node Mapping Studies

Despite the advent and growth of endoscopic and nephron-sparing management approaches, the mainstay treatment for upper tract urothelial carcinoma (UTUC) in 2025 remains radical nephroureterectomy (RNU). Classic teaching, largely derived from the benefit seen in the muscle-invasive bladder cancer (MIBC) population, supports the inclusion of retroperitoneal lymph node dissection (LND), particularly for high-risk and high-grade disease. However, no level 1 evidence exists supporting the inclusion of an LND at the time of extirpative surgery for UTUC. Moreover, studies attempting to map lymph node dissection relative to primary UTUC tumor location are plagued by limitations. Herein, we summarize and review available data regarding proposed LND templates for the management of UTUC.