title: The survival benefit of lymph node dissection at the time of removal of kidney, prostate and urothelial carcinomas: what is the evidence?
abstract: BACKGROUND
  Lymph node dissection (LND) has been advocated by oncologic surgeons to completely eradicate cancer. However, evidence for that strategy is solely based on poor quality data. Some randomized studies done outside the field of urology failed to show any benefit to LND. Our objective was to evaluate whether LND at the time of removal of prostate, kidney and urothelial carcinomas results in a survival benefit.
  
  
  METHODS
  For that purpose, we performed a systematic literature review.
  
  
  RESULTS
  For kidney cancer, LND might be able to cure some patients with N+ disease. In N0 patients, although a randomized trial has been completed, the value of LND remains uncertain. LND at the time of radical prostatectomy can be useful in some patients with lymph node invasion. However, studies on the impact of LND in pN0 patients are retrospective and conflictive. Extended LND has been recommended when performing a radical cystectomy based on improved outcomes observed in retrospective studies. However, these studies are limited by selection biases and results of ongoing randomized trials will specify the template and the advantages of LND when removing a bladder cancer. Recent data of large series of radical nephro-ureterectomies for upper tract urothelial carcinomas are conflicting. Some found a benefit of LND in N0 patients while others did not.
  
  
  CONCLUSIONS
  The studies that support LND at the time of surgery for prostate, kidney and urothelial carcinomas have low level of evidence. This should encourage urologists to design and perform well-designed randomized trials to assess the potential survival impact of a commonly done procedure.
authors.affiliation: Department of Urology, Rennes University Hospital, University of Rennes, 2, rue Henri Le Guillou, 35000, Rennes, France, Karim.bensalah@chu-rennes.fr.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Morgan
authors.initials: M
authors.lastname: Roupret
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Shariat
mesh_terms: D015653:Cystectomy; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000601:surgery; D008297:Male; D009392:Nephrectomy; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*