The role of lymphadenectomy in renal cell carcinoma.
OBJECTIVE
To critically appraise the current literature on the benefits of lymphadenectomy in patients with renal cell carcinoma. Many questions exist including: What is a 'standard' versus 'extended' lymph node dissection (LND)? What is the morbidity of a LND? What type of patient may derive the most benefit from LND? On the basis of preoperative staging, what is the benefit (therapeutic versus staging) for an individual patient? How does the performance of a LND impact current and future adjuvant and neoadjuvant studies?


RESULTS
Results from the EORTC 30881 trial did not show a therapeutic benefit to performing a 'standard' LND in patients with renal cell carcinoma, but the population predominantly comprised patients at the lowest risk of harboring lymph node metastasis. There are no prospective randomized trials with sufficient statistical power to analyze the therapeutic or staging effects in high-risk patients.


CONCLUSIONS
This review provides a synopsis of the available data regarding the therapeutic and staging benefits of lympadenectomy in the setting of renal cell carcinoma and should assist the urologist in educating affected patients as well as providing the urologist with the current evidenced-based data regarding this longstanding unanswered question.
Delacroix
Scott E
SE
Department of Urology, Unit 1373, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Wood
Christopher G
CG
D002292:Carcinoma, Renal Cell / Q000601:surgery*; D019317:Evidence-Based Medicine; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects; D049451:Nomograms