The authors present a good population-based analysis of potential staging and prognostic value of lymphonode dis-section (lnd) in patients with upper tract urothelial carcinoma treated with nephroureterectomy without metastatses vs no lnd. Although no survival benefit was found, some important issues were addressed. The authors state that surgeons are good judges of who requires lnd and in whom it may be avoided. They also point toward the relative lack of standardized indications as well as templates for this surgery. It is important to indicate that Secine et al and Margulis et al already indicated the importance of lnd at the time of surgery as there is a limited accuracy of preoperative staging of the regional lnd. Also, Kikuchi et al and Roscigno et al showed that lymphovascular invasion may be an independent predictor of clinical outcomes in nonmetastatic patients. All these taken together, the studies by Kondo et al attempting to standardize the templates for this procedure are noteworthy.
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