Revisiting the role of lymph node dissection in renal cell carcinoma

Lymph node dissection (LND) in renal cell carcinoma (RCC) is accepted as the most accurate and reliable staging procedure. Yet, in recent years, there has been a gradual decline in use of LND across Europe and the United States (1,2). This is likely due to its limited therapeutic benefit as LND has not been shown to improve overall survival (OS) or progression-free survival (PFS) (3). Currently, guidelines recommend LND only in patients with palpable or enlarged lymph nodes detected on preoperative imaging (4). Additionally, the extent of LND remains controversial. Few urologists in the United States (6.6%) remove more than 5 lymph nodes during radical nephrectomy (2). The negative predictive value of a limited LND is not well defined.