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

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.