Elsevier

European Urology

Volume 59, Issue 1, January 2011, Pages 24-25
European Urology

Platinum Priority – Editorial
Referring to the article published on pp. 18–23 of this issue
Lymph node dissection is not obsolete in clinically node-negative Renal Cell Carcinoma patients

https://doi.org/10.1016/j.eururo.2010.09.033Get rights and content

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Conflicts of interest

The author has nothing to disclose.

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    Unfortunately, the available technology is incapable of accurately identifying small LN metastases. It is not possible to view a normal-sized LN with micro metastases that will benefit from LND with current technology.12,13 Therefore, the absence of suspicion of LN metastasis from current imaging techniques should not convince the surgeon not to perform LND.13

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    In conclusion, the available technology is capable of accurately identifying only large lymph node metastases. At present, patients with (micro)metastases in normal-sized nodes who might benefit from LND [27] cannot be visualized by any of the above-mentioned techniques [4]. Therefore, when using the available imaging technology, the absence of any evident lymph node metastasis should not preclude the performance of a regional LND.

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    Crispen and colleagues reported similar figures. However, others have claimed that if the low morbidity and benefit to staging and possible treatment preclude the value of frozen section and in patients at risk, LAD should proceed.18 Communication between the urologist and pathologist is necessary so that an agreed procedure at their particular institution can be conducted until a consensus is reached.

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