CONTEXT: The oncological efficacy of routine lymphadenectomy (lymph node dissection [LND]) at the time of radical nephroureterectomy (RNU) remains controversial. OBJECTIVE: To systematically review the available literature assessing the impact of LND in upper tract urothelial carcinoma (UTUC) patients. EVIDENCE ACQUISITION: Embase, Medline, and Cochrane databases were searched for all studies comparing outcomes of patients undergoing RNU without LND versus any form of LND. We identified nine retrospective studies eligible for inclusion in this systematic review. We took cancer-specific survival (CSS) as the primary end point, and performed a narrative review and risk of bias assessment. EVIDENCE SYNTHESIS: Six studies compared outcomes of no LND versus LND. Three studies compared complete LND versus incomplete LND versus no LND. The incidence of pN+ in patients with high-stage (≥pT2) tumours ranged from 14.3% to 40%. Pre- and postoperative characteristics differed among the study groups, potentially biasing the results, as demonstrated by the risk of bias assessment, potentially favouring the LND group. Oncological outcomes such as cancer-specific, overall, recurrence-free, and metastasis-free survival were reviewed, demonstrating a survival benefit with LND in high-stage disease of the renal pelvis. CONCLUSIONS: Template-based and complete LND improves CSS in patients with high-stage (≥pT2) UTUC and reduces the risk of local recurrence. The impact of LND in ureteral tumours remains uncertain. PATIENT SUMMARY: Studies comparing radical nephroureterectomy with or without the removal of nodes (lymph node dissection [LND]) were analysed. LND improves survival in patients with high-stage disease of the renal pelvis, if it is performed according to an anatomical template-based approach.

A O U San Giovanni Battista le Molinette Department of Urology University of Turin Turin Italy

Academic Department of Urology La Pitié Salpétrière Hospital Assistance Publique Hôpitaux de Paris Paris France

Academic Urology Unit University of Aberdeen Scotland UK

Academic Urology Unit University of Aberdeen Scotland UK; Department of Urology Aberdeen Royal Infirmary Aberdeen Scotland UK

Department of Pathology La Pitié Salpétrière Hospital UPMC Paris France

Department of Surgical Oncology Netherlands Cancer Institute Antonie van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology Caritas St Josef Medical Centre University of Regensburg Regensburg Germany

Department of Urology Fundació Puigvert Universidad Autónoma de Barcelona Barcelona Spain

Department of Urology Fundación Instituto Valenciano de Oncología Valencia Spain

Department of Urology HELIOS Agnes Karll Krankenhaus Bad Schwartau Germany

Department of Urology Hospital Motol 2nd Faculty of Medicine Charles University Praha Czech Republic

Department of Urology Medical University of Graz Graz Austria

Department of Urology North Hampshire Hospital Basingstoke UK

Department of Urology Radboud University Nijmegen Medical Centre Nijmegen The Netherlands

Department of Urology University of Rennes Rennes France

Division of Gastroenterology Department of Medicine McMaster University Hamilton ON Canada

European Association of Urology Guidelines Office Brussels Belgium

Medical University of Vienna Vienna General Hospital Vienna Austria

References provided by Crossref.org

Need for and extent of lymph node dissection for upper tract urothelial carcinoma: an updated review in 2023

Diagnostic challenges and treatment strategies in the management of upper-tract urothelial carcinoma

Comparing oncological outcomes of laparoscopic vs open radical nephroureterectomy for the treatment of upper tract urothelial carcinoma: A propensity score-matched analysis