Abstract
Surgical extirpation of regional lymph nodes in the treatment of renal cell carcinoma (RCC) is currently accepted as the most accurate staging procedure for the detection of lymph node invasion. However, the therapeutic benefit still remains controversial. The renal lymphatic drainage is unpredictable, and the extent of lymph node dissection (LND) is a matter of debate. Small lymph node metastases cannot be visualised by the currently available imaging techniques. The European Organization for Research and Treatment of Cancer (EORTC) trial number 30881 shows that performing LND in patients with T1–T2 clinically node-negative (N0) RCC offers limited staging information and no benefit in terms of decreasing disease recurrence or improving survival. Numerous retrospective studies show that high-risk patients with advanced or metastatic disease should undergo LND because they may benefit from a therapeutic effect. However, in my opinion there is no reason today not to do an easy LND in all RCC patients who could have microscopic nodal disease and not only in high-risk patients. This means LND should be performed in all patients at risk and certainly in the actually selected RN candidates.
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