Optimizing Lymph Node Dissection at the Time of Nephroureterectomy for High-risk Upper Tract Urothelial Carcinoma

Suzanne Lange; Giorgio Calleris; Surena F Matin; Morgan Rouprêt

doi:10.1016/j.euf.2023.01.001

Optimizing Lymph Node Dissection at the Time of Nephroureterectomy for High-risk Upper Tract Urothelial Carcinoma

Eur Urol Focus. 2023 Mar;9(2):280-282. doi: 10.1016/j.euf.2023.01.001. Epub 2023 Jan 13.

Authors

Suzanne Lange¹, Giorgio Calleris², Surena F Matin³, Morgan Rouprêt⁴

Affiliations

¹ Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: slange@mdanderson.org.
² Sorbonne University, GRC 5 Predictive Onco-Urology Research Group, and Urology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Urology, University of Turin, Turin, Italy.
³ Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Sorbonne University, GRC 5 Predictive Onco-Urology Research Group, and Urology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.

PMID: 36642620
DOI: 10.1016/j.euf.2023.01.001

Abstract

Lymph node dissection (LND) has prognostic and possible therapeutic benefits in the management of high-risk upper tract urothelial carcinoma. However, LND use is low and difficult to monitor, so it is not easy to study LND outcomes and the true rate of use. Prespecified templates for complete node dissection and detailed reporting are imperative to critically assess the benefits of LND in future studies. Barriers to LND use may include fear of complications and difficulty in predicting which patients have high-risk disease. Methods to improve LND implementation include the use of strict templates with descriptive pathology reporting, nomograms for preoperative risk stratification, and LND as a quality indicator to monitor rates of use and guideline concordance. PATIENT SUMMARY: For patients with high-risk cancer of the upper urinary tract, removal of lymph nodes during surgery improves identification of the cancer stage and may have a therapeutic effect too. Further studies are needed to confirm potential therapeutic benefits.

Keywords: Lymph node dissection; Nephroureterectomy; Template; Upper tract urothelial cancer.

Publication types

Practice Guideline

MeSH terms

Carcinoma, Transitional Cell* / pathology
Carcinoma, Transitional Cell* / surgery
Humans
Lymph Node Excision / methods
Nephroureterectomy / methods
Ureteral Neoplasms* / pathology
Ureteral Neoplasms* / surgery
Urinary Bladder Neoplasms* / surgery