Radical nephrectomy should not blindly perform lymph node dissection

The prognosis of renal cancer mainly depends on the stage of the tumor. Simple radical nephrectomy is the first choice, and blindly expanding the scope of lymph node dissection during surgery is not recommended.

Nephrectomy plus regional lymph node dissection should be limited to patients with progressive renal cancer who have no distant metastasis before surgery, imaging examination shows retroperitoneal lymph node enlargement, or renal cancer invades the kidney periphery. The primary goal of adding lymph node dissection at this time is to clarify the tumor stage and guide the patient's postoperative treatment. Secondly, if conditions permit, the possibility of cancer cells and their spread in the body can be reduced by removing enlarged lymph nodes.

The prognosis of patients with renal cancer is mainly related to lymph node metastasis near the renal hilum. The lymph nodes in this area have been removed during radical nephrectomy, and most metastatic cancers are hematogenous. Further extended lymph node dissection does not improve the survival rate. Lymph node dissection may destroy the patient's local immunity. Therefore, blindly performing lymph node dissection on patients without lymph node metastasis will not only aggravate the surgical trauma, but also have a negative impact on systemic and local immune function. Since extended radical nephrectomy takes a long time and causes a lot of bleeding, it is a great blow to patients. In particular, radical surgery for large kidney cancer is a high-risk surgery, which greatly increases the incidence of surgical complications and mortality. Therefore, it is not recommended to perform regional lymph node dissection or extended lymph node dissection indiscriminately.