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Metastatic Nodal Pattern: Is There a Role for Paraaortic Lymph Node Dissection

  • David M. Golombos
  • Patrick Lewicki
  • Jullet Han
  • Douglas S. Scherr
Chapter

Abstract

The role of lymphadenectomy for upper tract urothelial carcinoma remains an area of controversy, as is the case for many urologic malignancies. Due to vast networks of vascular and lymphatic channels, urothelial carcinoma of both the bladder and upper tract represent diseases where evaluation of the role of meticulous lymph node (LN) dissection has attracted considerable interest from urologic surgeons. Upper tract urothelial carcinoma has the additional consideration of laterality and asymmetry of great vessels and renal vasculature. However, it has a relatively low incidence, which in part has resulted in far fewer studies evaluating the role of LN dissection, and has prevented a full understanding of both its benefits and the optimal extent of dissection to achieve them. That said, the results from multi-institutional studies by high volume centers have supported the beneficial role of LN dissection, more convincingly in staging, but possibly in improving oncological outcomes in select patients. Randomized controlled trials are required to generate a greater level of evidence to create defined templates and establish the role of LN dissection in surgical management of upper tract urothelial carcinoma.

Keywords

Upper tract urothelial carcinoma Lymphatic metastasis Nephroureterectomy Regional lymph nodes Lymphadenectomy Staging Survival 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • David M. Golombos
    • 1
  • Patrick Lewicki
    • 2
  • Jullet Han
    • 2
  • Douglas S. Scherr
    • 1
  1. 1.Department of UrologyNew York Presbyterian Hospital—Weill Cornell Medical CenterNew YorkUSA
  2. 2.Department of UrologyWeill Cornell Medical CollegeNew YorkUSA

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