Can Retroperitoneal Lymph Node Dissection (RPLND) be feasibly performed to prolong survival in Renal Cell Carcinoma (RCC) with limited lymph node involvement? An Analysis of Recurrence Patterns

Tachibana, Isamu; Vasquez, Ruben; Mahmoud, Mohammad; Kern, Sean; Patel, Rushi; King, Jennifer; Adra, Nabil; Boris, Ronald S.; Cary, Clint; Rice, Kevin R.

doi:10.1016/j.urolonc.2022.08.006

Cited by 2 publications

(7 citation statements)

References 11 publications

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“…Improved survival was found among a small subset of patients who underwent LND at the time of nephrectomy. Gershman et al found durable survival for patients with isolated LNI, and similar results were shown by Tachibana et al for patients with limited nodal disease (1-2 positive lymph nodes) who underwent LND [21,22]. Their findings suggest that patients with less aggressive RCC may benefit from LND, but only a few studies have been able to establish a link between LND and possible survival advantages.…”

Section: Evidence Supporting Lymph Node Dissectionmentioning

confidence: 55%

The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma

Ngai

Chandrasekar²,

Bratslavsky

et al. 2023

JCM

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Purpose: To explore the current role of lymph node dissection (LND) in the management of nonmetastatic localized renal cell carcinoma (RCC). Background: There is currently no proven benefit of LND in the setting of RCC, and its role remains controversial because of conflicting evidence. Patients who may benefit from LND are those at greatest risk of nodal disease, but the tools used to predict nodal involvement are limited due to unpredictable retroperitoneal lymphatics. The indications, templates, and extent of LND are also not standardized, adding to the ambiguity of current guidelines surrounding its use. Evidence Acquisition: A PubMed search of the literature from January 2017 to December 2022 was conducted using the search terms “renal cell carcinoma” or “renal cancer” in combination with “lymph node dissection” or “lymphadenectomy”. Case studies and editorials were excluded, whereas studies investigating the therapeutic effect of LND were classified as either demonstrating a benefit or no benefit. References of the studies and review articles were also searched for notable studies and findings that were outside the five-year literature search. The studies in this review were restricted to the English language. Results: Only a number of studies in recent years have found an association between the extent of LND and increased survival. Most studies do not indicate an associated benefit, and some even suggest a negative effect on survival. Most of these studies are retrospective. Conclusion: The therapeutic value of LND in RCC is still unclear, and although prospective data are needed, its declining rates and emerging new therapies make this unlikely. A better understanding of renal lymphatics and improved detection of nodal disease may help determine the role of LND in nonmetastatic localized RCC.

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Section: Evidence Supporting Lymph Node Dissectionmentioning

confidence: 55%

The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma

Ngai

Chandrasekar²,

Bratslavsky

et al. 2023

JCM

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“…There are only few studies assessing complications after LND [31]; however, Tachibana et al reported that operation time, perioperative morbidity, and length of hospitalization were comparable between extended and limited LND. Postoperative complications were, however, more common in the limited LND group [22 ▪ ]. On the contrary, Xiao et al showed that postoperative complications were two-fold higher in RCC patients who have venous thrombus who undergo LND compared with those who did not undergo LND [12].…”

Section: Complications and Surgical Approaches Of Lymph Node Dissectionmentioning

confidence: 95%

“…These data suggested that a wider extent of LND is desirable when nodal metastases are suspected. Unfortunately, the extent of LND depended on the surgeon's discretion today or can be seen in published studies [6,16,18,20,22 ▪ ]. Therefore, high-quality research is needed to identify which template to use and when to use it.…”

Section: Extent and Template Of Lymph Node Dissectionmentioning

confidence: 99%

“…Only one study described the extent of LND in the last two years. Tachibana et al showed that a template LND provided a significantly better OS than a limited LND in 45 patients with 1 or 2 pathologically confirmed nodal metastases [22 ▪ ]. They resected a median of 18 LNs using the template with, six of 22 patients who underwent a limited LND experiencing retroperitoneal recurrence within the template of LND.…”

Section: Extent and Template Of Lymph Node Dissectionmentioning

confidence: 99%

“…The extent of LNDs is reported to be associated with an increased risk of intra- and postoperative complications [22 ▪ ]; LND for RCC patients required the dissection around the major vessels with the risk of bleeding, and other concern is a higher risk of chylous ascites [31]. There are only few studies assessing complications after LND [31]; however, Tachibana et al reported that operation time, perioperative morbidity, and length of hospitalization were comparable between extended and limited LND.…”

Section: Complications and Surgical Approaches Of Lymph Node Dissectionmentioning

confidence: 99%

See 2 more Smart Citations

Role of lymphadenectomy during primary surgery for kidney cancer

Bekku

Kawada

Yanagisawa

et al. 2023

Current Opinion in Urology

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Purpose of reviewLymph node dissection (LND) during radical nephrectomy (RN) for renal cell carcinoma (RCC) is not considered as a standard. The emergence of robot-assisted surgery and effective immune checkpoint inhibitors (ICI) in recent years may change this and lymph node (LN) staging has become easier and has a clinical impact. In this review, we aimed to reconsider the role of LND today. Recent findingsAlthough the extent of LND has still not been well established, removal of more LN seems to provide better oncologic outcomes for a select group of patients with high-risk factors such as clinical T3-4. Adjuvant therapy using pembrolizumab has been shown to improve disease free survival if complete resection of metastatic lesions as well as the primary site is obtained in combination. Robot assisted RN for localized RCC has been widespread and the studies regarding LND for RCC has been recently appeared.

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Can Retroperitoneal Lymph Node Dissection (RPLND) be feasibly performed to prolong survival in Renal Cell Carcinoma (RCC) with limited lymph node involvement? An Analysis of Recurrence Patterns

Cited by 2 publications

References 11 publications

The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma

The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma

Role of lymphadenectomy during primary surgery for kidney cancer

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