Routine lymph node dissection in the treatment of early stage cancer: are we doing the right thing?

The role of elective lymphadenectomy in the treatment of patients with early-stage malignancies, although still commonly performed, remains a matter of controversy. This issue is important in the management of cancers and raises questions about the biologic interpretation of their natural history and about motives for surgical intervention. When regional nodes are clinically involved, there is no debate that a therapeutic dissection is indicated. However, the issue in question is the indication for lymphadenectomy in the absence of clinically involved regional lymph nodes. In recent years, the universal acceptance of the Halstedian/Wertheim-Meigs concepts of wide en bloc resection of the primary tumor together with the lymphatic pathway of spread has in part changed. In a great number of early-stage solid tumors, a less radical approach has dramatically reduced the morbidity and mortality of such treatments while resulting in equal salvage rates. In addition, recent immunological studies on the developmentof antitumor reactivity in regional draining lymph nodes argues against prophylactic lymph node dissection in cancer and advocates the maintenance of the integrity of the immune system.