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Review Open Access

Lymphadenectomy in upper tract urothelial carcinoma: Clinical insights and controversies (Review)

  • Authors:
    • Dihao Lv
    • Yinglong Huang
    • Haihao Li
    • Shi Fu
    • Chen Gong
    • Chadanfeng Yang
    • Jiansong Wang
    • Haifeng Wang
    • Zhiyong Tan
    • Mingxia Ding
  • View Affiliations / Copyright

    Affiliations: Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan 650101, P.R. China
    Copyright: © Lv et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 137
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    Published online on: August 8, 2025
       https://doi.org/10.3892/or.2025.8970
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Abstract

Upper tract urothelial carcinoma (UTUC), a relatively rare but highly malignant tumor arising from the renal pelvis and the urothelial layer of the ureter, accounts for 5‑10% of all urothelial malignancies. The lack of specific early symptoms commonly results in a delayed diagnosis, with >60% of cases being diagnosed at an advanced stage of the disease. Lymph node involvement can critically affect the clinical outcomes, thus serving as a key prognostic indicator, guiding both staging protocols and treatment strategies. Lymphadenectomy, typically performed alongside radical nephroureterectomy, not only assists in evaluating the extent of the regional metastases, but also plays a critical role in guiding both staging and treatment planning. Although several studies have suggested that a more extensive lymph node dissection (LND) can improve cancer‑specific survival and disease‑free survival rates, there is still no consensus on the optimal extent of dissection or a universally accepted surgical template. The present review aims to summarize the existing evidence on the efficacy of LND in UTUC, thus emphasizing its potential in staging, outcome prediction and possible survival benefits. The review also aims to address the challenges caused by inconsistent LND practices and the limited availability of robust prospective data. Furthermore, it discusses novel biomarkers that could improve patient classification, and proposes future research directions to improve the management of UTUC through more personalized and evidence‑driven LND strategies.
View Figures

Figure 1

Regional lymphovascular drainage
depending on the location of the primary tumors according to the
studies by Matin et al (18)
and Kondo and Tanabe (9). Regional
nodal sites for the renal pelvis and the (A) upper ureter, (B)
middle ureter and (C) distal ureter, with yellow circles
representing the right side and green circles representing the left
side. 1, renal hilar; 2, paracaval; 3, retrocaval; 4, paraaortic;
5, interaortocaval; 6, common iliac; 7, external iliac; 8, internal
iliac; 9, obturator; 10, suprahilar; 11, aortic bifurcation; 12,
presacral.

Figure 2

Templates for lymphadenectomy based
on the primary tumor location according to the studies by Matin
et al (18) and Kondo et
al (19). (A) Right renal
pelvis and upper ureter (red box: Renal hilar, paracaval and
retrocaval LNs). (B) Left renal pelvis and upper ureter (yellow
box: Renal hilar and paraaortic LNs). (C) Right middle ureter
(green box: Interaortocaval LNs). (D) Left middle ureter (orange
box: Paraaortic LNs). (E) Right distal ureter (purple box: Common
iliac, external iliac, internal iliac and obturator LNs). (F) Left
distal ureter (blue box: Common iliac, external iliac, internal
iliac, obturator LNs). 1, renal hilar; 2, paracaval; 3, retrocaval;
4, paraaortic; 5, interaortocaval; 6, common iliac; 7, external
iliac; 8, internal iliac; 9, obturator. LN, lymph node.
View References

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Lv D, Huang Y, Li H, Fu S, Gong C, Yang C, Wang J, Wang H, Tan Z, Ding M, Ding M, et al: Lymphadenectomy in upper tract urothelial carcinoma: Clinical insights and controversies (Review). Oncol Rep 54: 137, 2025.
APA
Lv, D., Huang, Y., Li, H., Fu, S., Gong, C., Yang, C. ... Ding, M. (2025). Lymphadenectomy in upper tract urothelial carcinoma: Clinical insights and controversies (Review). Oncology Reports, 54, 137. https://doi.org/10.3892/or.2025.8970
MLA
Lv, D., Huang, Y., Li, H., Fu, S., Gong, C., Yang, C., Wang, J., Wang, H., Tan, Z., Ding, M."Lymphadenectomy in upper tract urothelial carcinoma: Clinical insights and controversies (Review)". Oncology Reports 54.5 (2025): 137.
Chicago
Lv, D., Huang, Y., Li, H., Fu, S., Gong, C., Yang, C., Wang, J., Wang, H., Tan, Z., Ding, M."Lymphadenectomy in upper tract urothelial carcinoma: Clinical insights and controversies (Review)". Oncology Reports 54, no. 5 (2025): 137. https://doi.org/10.3892/or.2025.8970
Copy and paste a formatted citation
x
Spandidos Publications style
Lv D, Huang Y, Li H, Fu S, Gong C, Yang C, Wang J, Wang H, Tan Z, Ding M, Ding M, et al: Lymphadenectomy in upper tract urothelial carcinoma: Clinical insights and controversies (Review). Oncol Rep 54: 137, 2025.
APA
Lv, D., Huang, Y., Li, H., Fu, S., Gong, C., Yang, C. ... Ding, M. (2025). Lymphadenectomy in upper tract urothelial carcinoma: Clinical insights and controversies (Review). Oncology Reports, 54, 137. https://doi.org/10.3892/or.2025.8970
MLA
Lv, D., Huang, Y., Li, H., Fu, S., Gong, C., Yang, C., Wang, J., Wang, H., Tan, Z., Ding, M."Lymphadenectomy in upper tract urothelial carcinoma: Clinical insights and controversies (Review)". Oncology Reports 54.5 (2025): 137.
Chicago
Lv, D., Huang, Y., Li, H., Fu, S., Gong, C., Yang, C., Wang, J., Wang, H., Tan, Z., Ding, M."Lymphadenectomy in upper tract urothelial carcinoma: Clinical insights and controversies (Review)". Oncology Reports 54, no. 5 (2025): 137. https://doi.org/10.3892/or.2025.8970
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