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Contemporary role of lymph node dissection at the time of radical nephroureterectomy for upper tract urothelial carcinoma

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Abstract

Purpose

To review the contemporary data on the role of lymph node dissection (LND) at the time of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

Methods

A computerized bibliographic search using the following protocol (“Nephroureterectomy”) AND (“Lymphadenectomy” OR “Lymph node” OR “Lymphatic”) was performed in MEDLINE to identify all original and review articles that addressed the role of LND for UTUC.

Results

Regional lymph node (LN) boundaries of UTUC have been recently investigated in mapping studies to propose anatomic templates of LND according to the laterality and location of primary tumor. Although these anatomic templates remained poorly described, most reports supported the staging benefit of LND that allowed for risk stratification of patients with (pN+) or without (pN0) LN metastases from those who did not undergo such a procedure (pNx). In addition, the therapeutic benefit of LND at the time of RNU was supported by better oncological outcomes obtained after complete LND when compared to incomplete or no LND, especially in the group of patients with advanced disease. The number of LNs removed was also correlated with both, more accurate staging and greater cancer-specific survival after LND, whose feasibility and safety have been validated in prospective studies.

Conclusions

Despite mostly based on data with level of evidence 3, our comprehensive review of the literature supports the staging and therapeutic benefits of LND at the time of RNU for UTUC, which are particularly significant for patients with muscle-invasive or locally advanced disease.

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Author contributions

Seisen, Rouprêt, Shariat, Colin and Cussenot were involved in protocol/project development. Seisen and Peyronnet were involved in data collection or management. Seisen, Rouprêt, Shariat and Colin were involved in data analysis. Seisen, Rouprêt, Shariat, Colin, Cussenot and Renard-Penna wrote and edited the manuscript. There are no other contributor to this study.

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Authors and Affiliations

  1. Academic Department of Urology, Pitié-Salpêtrière Hospital, APHP, 47-83 boulevard de l’hopital, 75013, Paris, France

    Thomas Seisen & Morgan Rouprêt

  2. GRC - UPMC n° 5, ONCOTYPE-URO, Institut Universitaire de Cancérologie, UPMC University Paris 6, 75005, Paris, France

    Thomas Seisen, Olivier Cussenot & Morgan Rouprêt

  3. Academic Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Vienna, Austria

    Shahrokh F. Shariat

  4. Academic Department of Urology, Tenon Hospital, APHP, 75020, Paris, France

    Olivier Cussenot

  5. Academic Department of Urology, CHU Rennes and University of Rennes, Rennes, France

    Benoit Peyronnet

  6. Academic Department of Radiology, Pitié Salpêtrière Hospital, APHP, 75013, Paris, France

    Raphaële Renard-Penna

  7. Department of Urology, La Louvière Private Hospital, Lille, France

    Pierre Colin

Authors
  1. Thomas Seisen
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  2. Shahrokh F. Shariat
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  6. Pierre Colin
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  7. Morgan Rouprêt
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Correspondence to Morgan Rouprêt.

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Seisen, T., Shariat, S.F., Cussenot, O. et al. Contemporary role of lymph node dissection at the time of radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 35, 535–548 (2017). https://doi.org/10.1007/s00345-016-1764-z

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  • DOI: https://doi.org/10.1007/s00345-016-1764-z

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